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� <br />� <br />CI'I .:VERrTT PERb1IT N0. <br />DEPAP.7';d!;1'.7` OF CO?ii�1U;17TY LEVELOPMENT <br />BGiLDI:�G P �TudI1` APPLICi."i IQ:J VALUATION C�_(7 ' � <br />PEIu�lIT FEE > � �- <br />DI�TE (�.ua�'?(p�l�•�%� <br />—�— <br />ADDRESS OP CONSTP.UCTION i40RK ��32Cj M�v�, i ,,, „y '�, ,(� q <br />LEGAL DESCRIPTION: LOT '�__ BLOCK PLAT'(NA��� I�ClG61�i <br />UNPLATTED DGSCRIPTION <br />BUILDING DESCRIPTION: NES•7 ADDITION 'X REp10DEL <br />— OR REPAIR <br />#' OF UNITS ONE OCCUPA:�CY OR USE Y1=S STORIES Q�� <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: YES NO x <br />CONTRACTOR �, QQL,.,,N ().)p.,�„�� (J�,� OS�NER �, { �: W.Q�,.�o.Q,n.� <br />NiAILING biAILING <br />�wnt�ss 2,Qo2 t) �.a..�.�n.�.� ADDRESS t3'2�i 7�K�.�a <br />�,�.�.�:�, (.u�;..Ll1ti. �v�n-,�a-� , W a _ <br />� <br />PHONE IdU:IBER 2�� —[�7j(yv PHONE NUhiBER <br />CONTRACTOR'S LICENSE NUt•iBER �'? Z� —D�—�C.�,l�� <br />SIGNATURE �����p�„� �a Aa Q <br />NOTE: TH� APPLICANT SAALL FILL Iid ALL ABOVE BLT�IQKS C0:•IPL�TELY It1CLUDING <br />TIIE PLOT PLi>;C Sc;E_CSi 0`7 REAP OF THZS SIiEST. TfIE APPLICA`:T IS RESPOI45IBLE <br />POR ALL ItdFO??:_tiTIOD: i•:HICH IS FU?.]ISFIED ON THE APPLICATIOi:. ANY CHAD]GES <br />IN THE INrORidAT20N, PLOT PLAN OR BUILDING PLANS SHALL BE SUIIb1ITTED TO TIi� <br />INSPECTION DIVISIO.: FOR APPROVAL BEFORE PROCEEDING i9ITH �HE CONSTRUCTIOid <br />WORK. . //A`�� <br />�� <br />APPP.OVAL: , <br />1. PLANNING '� DATE � ` z � � � <� <br />2. ENGINEEP.ING <br />TRAI'PIC DIVTSIOi� <br />S•7ATL•'R SERVICE <br />S��9ER SERVICE <br />PUIILIC SGRVICE SECTION <br />?. INSPECTION DEP}1RTP NT/ I <br />/ >.�i � v i %�'� <br />4. FIRE t�:�R511AL <br />-,� -z�.� 4 <br />�i�� <br />,I- - 7-�- . "��-I <br />NOTE: eILL COI:STF.UCTIOid I•:OP.fi SIIALL C0;•SPLY S•7ITFi APPLICF.PL� COD�S, t10TES <br />ON DItA[aINGS, nr�n IIvSi'i:C1'IOi1. <br />c��iQC.�— �i�/�l% �' �1�Cr%'. <br />