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. . _ .. <br /> 'CITY� OF F:VER:TT PI:IL+iIT NO. �,G�2� <br /> DEPAP.TP1lit:" OL' COD1h1UNITY DGVIiI�OPMENT <br /> IIUILDII�G P�12i�iZT A3'YLICelTIOIv' V)1LUATION ��Q2 <br /> � d r7 PEIL+IIT FL•'L �,� <br /> DI�TE ,��7�/ �_ —• <br /> �� � �U�Hr�� <br /> ADDRESS OP CONSTRUCTION WORK � <br /> . o o vcr.]� <br /> LEGAL DIiSCRIPTION: LOT � /�S� SLOCK ��_ PLAT ,� <br /> ' UNPLATTED D�SCRIPTION <br /> / <br /> REMODEL <br /> BUILDING DESCRIPTION: NEW _ ADDITION OR REPAIR i� <br /> # OF UNITS (J OCCUPI�NCY OR USE � STORIES �— <br /> IS T$IS A CHANG OF BUILDING OCCUPANCY: YES NO �/ <br /> �CO�ITRACTOR � G �,Pc,, �y/ OWNER �U/!�✓F �v�x� <br /> MAILING .�.� <br /> ADDRESS oZ�'2(T� ,G�Gf/ L�O/IIOA'PS ADDRESS �QD�� NEL✓/// All,�' <br /> /'r'� .z,�fAE�T u/.s+s�— <br /> PHONE NUMBEP. ��G � ,� zGx PHONE I7UDIBER _ �S:]= OC�� <br /> CO:�TRACTOR'S L ENSE NUDSEER �,a3 �- o� "` 7.� �� _ <br /> 9 <br /> SIGNATURE � lQ0 n � � � ,f,(�`(�(.L�. — <br /> NOTE: '�'HE APPLICANT SHALL FILL I:7 ALL ABOVE BI,F�NKS CO.IPLETELY IN�:.LUDING <br /> THE PLOT PLF.�7 SKETCH ON REAR OF THIS SIiEET. TIiE APPLICANT IS RESPONSIBLE <br /> FOR ALL INFO?2i�1ATI0N i:H2CH IS FURNISHED ON THE APPLICATION. ANY CHANGES <br /> IN THE INFORhtAiIOK, PLOT PLAN OR BUILDING PLANS SHALL T3E SUBMIT TO TY.E <br /> INSPECTION DIVISIOiQ FOF APPROVAL BEiORE PROCEEDING WITH T� TRUCTION <br /> WORK. <br /> � --,��" <br /> APPROVAL: <br /> 1. PLANNING DATE <br /> 2. ENGINF.�RING _ <br /> TRI�rFZC DIVISi0i4 <br /> WATL;R SSRVICli <br /> SEWER SERVICE <br /> PUIILIC SEP.VICE SEC2'ION _ <br /> .'•. INSPECTION DEPARTD1Ef]T � � � <br /> 4. FIFB !•I�1RSllAL � <br /> NOTB: ALL COA'STPUCTIOid S':OR?: SII�ILL C0�•iPLY S•;ITII APPLICAF3L?� CODES, IdOTES <br /> ON DRA�aI1dGS, AND INSPiCTIOivS <br />