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V <br />CI'PY OF I'VI:R?iTT . <br />DEPN?7^.?l;''ll` OS' COA]e9UNI'PY DSVELOPC4EN'P <br />13UILDI:ZG ]?lii:�I1T i�PPL2Ci'.TIO:Q <br />�� <br />DATE `% `c' 3 ' ._. <br />1 <br />r�raKz�r No. / S ! 7 � <br />9/o?s' >c! <br />VALUi�T20N LJ�/_�',�; <br />YL''Ri�iIT YEE 32�= <br />i <br />ADDRESS OF CONSTRUCTIOId WORFC �� �-�f�S �Gi;1C%�'JF'G� <br />L�GAL D�SCRIPTION: LOT f ��`�' /,,; BLOCK i.:J PLAT ��cic tiN.t'S7 <br />UNPLATTED D�SCRIPTION S �v . � yi+ /2E � 7 a:' l/ ,.?r f :• / ^'% /y'��+ �' / <br />�� %./ •:�•�.,- �, . il' �, ' ' <br />BUILDING D�SCRIPTION: NEi9 ADDITION REDIODE;L `/ , <br />— OR REPAIR \ <br />n' OF U:IITS OCCUPi�NC'1 OR USE�� :; ,+.'C ,•,�:.;�r,•; STORIES �_ <br />IS TfIIS A CHANGE OP BUILDING OCCUPANCY: <br />7 <br />CONTRACTOR r�"•ST�� ..'±•;,;.: ';�;, •Y ', . <br />I�`.AILI�G ^ . <br />ADDRESS .� l�i'�.S I�% ,� N, r� . <br />,�,^.,;�E-�: �•:I1S<l. ;' <br />PHONE NL'D;BER '. ' '� ' . !' . � ` � <br />CONTRACTOR'S LICENSE NUDIBEF <br />SIGNATURE :i� . � ,� ', .✓�� ' � • <br />YES <br />NO �'� <br />0�9NER /�( ! ,� <br />bSt1ILING , . � ,,..�,�,�, � . <br />ADDR�35 . .f-'r:^ v :.<", . � , <br />PI�ONE NUDSBER <br />:y� '•,`/-�"�'�;fl <br />. ' r <br />�ti ,,,. <br />���. •� _ ��'e"� <br />NOTB: TIiE APPLIC7INT SHALL FILL IN ALi AIIOVE BLANi�E'i COI•SPLETELY ItdCLUDI`T.G <br />THE PLOT ?iF,:� Si:i:TC!I 0`: R�i�R qF THIS u?iELT. T[IE APPLICAP!T IS RESPOtQSII3LE <br />I'OR I�LL I':FC� �TI0:7 Fi:?ICII IS FURidISIIFD ON TIIE ]1PPLICATION. ANY CIiANGES <br />IN TflE INFOILdATION, PLO1 PLa?�7 OR BUILDING YLANS SHaLL ES GUuLiIT'iEL TU 'i':!E <br />INSPECTI0:4 DIVISI0:4 FOR APPROV,T�L B�FORE PROCEBDING [9ITH TFiE ONSTRUCTIO:i <br />WORK. , /�����. <br />I�PP ROV�1L : <br />1. PLT�NNING <br />2. I:IQGIi:EER2NG <br />TRiiL'I'IC DIVI;iIOi� <br />i9e'�TliR S�RVIC� <br />SBA'ER S�RVICE <br />4 <br />DATE <br />PUBLIC S�RVICE SECTIO� <br />INSPECTION DEPARThfEi]T J��(�,eo CJl' (f/�t_.r.�e_ <br />I'II;r .'•;�`,RSI171L <br />,L "�� %�f <br />�— <br />NOTP: ALL CO'7STP.UCTZOid F:ORF; SIIALL CO:IPLY P7ITFI APPI,ICABLli CODI:S, DI07.'BS <br />ON DP.1S•iI:1GS, AND IIvSPEC'PIO:IS <br />