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APPLICATION FOR HOUSE iVUMeER <br />Date 23 Jdri. 54 <br />Scrcet _-Madzs,�n <br />' �, - <br />Number Ass�qnod_ 916 � <br />Name Ja!nes W. Bortner <br />----- Phone <br />Present Address ___ NEW ?�pt <br />Leyal Description of Property _Lot #5 BeV. Hllls Adh_�5 <br />CITY O; EVEP.ETT <br />ENGI;JEERING DEI'qRTMENT <br />FOHM NO. 4�G-007 �,.,.,«. <br />Issued by <br />