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V <br />CI'i'�' OF I:VI'RP.TT <br />pI;PAP,TFiPId'P OIi C0I9i�lUP7.T.7'Y DEVl'.LUPMENT <br />IIUILDII�G Plilu.11T Al'YLICi,TIOIv <br />DIiTG <br />� <br />PLTth1IT N0. <br />VALU7ITION <br />1'LP1�1IT FliE <br />_ ' <br />— �� D�c' <br />ADDRESS OP CONSTRUCTION WORK �,�' � s ;�.., <br />' �i ^.�. <br />a lSJ('_._ V�� .A i.' <br />_ ir• ., .�', ��' ��.- .. <br />LLGAL ')ESCP.IPTION: LOT <br />i1NPLATTED D�SCRIPTION <br />BLOCK _ PLAT <br />BUILDING DESCRIPTION: NEW ADDITIQN R�PSODEL <br />OR REPAIR X <br />$ OI' UNITS _ OCCUPANCY OR USE STORIES j <br />�S TH7S A CI�ANGE OP' BUILDING OCCUPANCY: YES NO i; <br />CONTRP.CTOR /YI n � <'� r,:�;l r.. � �_: . I�: <, <br />MI�ILING <br />ADDI2ESS ,�..3`I2:i -S'/ `y r1v=. ,$ r- <br />l.Cl ��<. i i 4• o� 1 � �• '\w ti S I•� �i t'- •'Y ) <br />PHONE NUMBER _ y'6 ;-• _. � � �, y � <br />OWN�R f.' (.J i <br />h:AILING <br />ADDRESS �,r:. -. ;. �1 �d. , . ti . <br />.� <br />.Gc'!�1}�� ��' It�t�i `I:C.i <br />PHONE NUt•i13ER y�-/ J —i �/�1- <br />CONTRACTOR'S LICENS� NUt•1BER i�:�._j _ c-�/ _ i1„jm,� ��j,i',r� �� -c�/'�� <br />SIGNATU , � � ,��� . �7� <br />' _/�> <br />i �- i <br />N01'�:� THE RPPLICANT SHALL FILL IN ALL ABOVE BLnI;FCS CO.dPLL,TELY INCLUDING <br />THE PLOT PLi:DI S,CETCIi O`: R�AR OF THIS SFIELT. TII� t1PPLIrAD?T IS RESPONSIBLE <br />rOR ALL ItdFOR�iaTION i•;i:IC:i IS FURi7ISHED ON THE AYPLICATION. ANY CIitIt�GES <br />IN TIIE I?JFORi•f71iI0N, PLOT PLAN OR RUILDING PLANS SHALI, Bli SUIIhiITTED '1'O Ti?E <br />IidSPECT20.] DIVISIOiQ L'OP. APPROVAL BEFOPB PROCEL�'DIi:G i$ITH TIIE CONSTRUCTIC�: <br />WORK. <br />71PPROVrIL: <br />1. PLANNING <br />2. ENGINEEP.ING <br />TR1f1FIC D?',I1;,10IQ <br />Y7ATLR SLRVICP•, <br />SS{VER SERVICE <br />PUI3LIC SERVICE SECTION <br />'. INSPECTION D�PnRT�fENT <br />4. FIFL•' 2•;112;SFIAL <br />DAT� <br />��� <br />� <br />NOTL: AT�L COt`:STP.UC'i'IOi] h:0;:_; ;iIIALL CO?1PLY WITtl IIPPLICA.'3Lli CODES, idOTES <br />Oid D^J�I9I[dGS, P.ND IIvSPECPION: <br />