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�.: •, <br />: ;' <br />� <br />� <br />i <br />n <br />crTi. or• rvsar.2�� <br />DEPAP,9';•itit�7` OP C i9i�]UN7'P DBI�ELOPDiENT <br />BUILD7IdG Pl:fv�lI i�l`PLT ATION <br />DATH . �i �% <br />rLRrizm No. %�C�,� /0/3�jy <br />Vr1LUATION { - ) . �T' <br />PElu�SIT FL''E <br />� . � '� -��, 'i-l�til� N'L,'� <br />ADDRESS OL' CONSTR CTION i•70RK )/ f- �-- /�- — % <br />/ 2=/ '7� <br />LEGAL DESCRIPTION: LOT p/� BLOCK .�_ p�+T•fk:"��L°' 7 °r���k'.� <br />UNPLATTED DESCRIPTI <br />BUILDING DLSCRIPTION: <br /># OF UNITS <br />NEW ADDITION REhiODEL <br />OR REPAZR /l�/ <br />OCCUPANCY UR USE STORIES <br />IS TFIIS A CHANGE OF BUILDING OCCUPANCY: <br />CONTR}1CTOR C C LL�2t� . �.[.:.- �%LC;. <br />MAI ING <br />ADD SS � 2 Z�- c�) l j,"-��.�,C-c : <br />� <br />� �--rL�LC�C;c__ l- �[-� <br />PHONE NUhIBER �iCL- �� ' .� I � U <br />CONTRACTOR'S <br />SZGNATURE <br />r <br />TFS NO <br />0�9NER <br />b7AILING <br />ADDRESS <br />PHONE NUAIBER <br />n / _. l =7�'7 <br />NOTE: TH� APPLIC:I�NT SHALL FILL IN aLL ABOVE BLANKS CO�iPLETELY ItdCLliDS?IG <br />TIiE PLOT PLAt� Si:ETCI] Oi: REAR OF THIS SHEET. TIII: APPLICANT IS RESPONSIBLE <br />FOR ALL INl'OR�LITIOI� �4HIGI IS FURNISHED ON THE APPLICATION. ANY CIiAhGiS <br />IN THE INFORi•SATION, PLOT PLAN OR BUILDING PLANS SHALL BE SUBMITTED TO TIiB <br />INSPECTIOid DIVISIO;d I'OR APPRO�'r1L BEFORE PROCEEDING [�TITH T.I1E CONSTRUCTION <br />WORK. <br />APPROVAL: <br />1. PLANNING <br />2. ENGII�T•.�RING <br />TRI�rPIC DIVISIOIQ <br />WATliR S�RVICE <br />S��•:ER SEP.VTCE <br />PUBLIC SCRVICE SECTZON <br />�. <br />4. <br />I�SP�CTTON D�PART�I�NT <br />FIRS h:�IP.SIIAL <br />DATE <br />NOTE: At,L CQi:STi:UCTI0�1 S•;01:',: Si?�ILI, C0:•IPLl �•:ITII APPLICARLP CODES, DIOT?1S <br />0[•7 DP.i�f•]INGS� AND I?•:tii�iSC'PIOi�S <br />