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CT.T)' OF L'VIil11,T'1' <br />DRPAWITIRNT OF COPNIINITY Dlil'1{T.orm NT <br />BUILDING PERMIT APPLICATION <br />DATE i9 i� <br />ADDRESS OP CON STUCTION WORK <br />LEGAL DESCRIPTION: LOTS Des fir" I BLOCK <br />WTFXIT- <br />UNPLATTF.D DESCRIPTION: <br />7 <br />VALUATION <br />PIMMIT FEE <br />REMODEL <br />BUILDING DESCRIPTION: NTId ADDITION — or REPAIR <br />OCCUPANCY OR USE <br />IIEIGHTS IN STORIES <br />IS THIS A CIIANGE OF BUILDIEC OCCUPANCY: YES. NO <br />CONTRACTOR OwINER _ G� rN_ `/•,'I}i ,,�4 �iNSO/(i ._ <br />IMLIEG ?•'AILING <br />ADDP.ESS -- — ADDRESS <br />PHONE NUI•ID P. <br />CON'rR/,CTOR'S LICENSE MUbGER <br />SIC17"'T'URE <br />PHONE 1;UPIL'P.R <br />NOTId: THE APPLICANT SHALL FILL III ALT, A1;0Vl: BIANKS COMPLETEILY IL'CLUDI3G THE PLOT PLAN <br />SKrTCli ON REAL: OF THIS S1L'3ET. TI11', APPLICANT IS B.i 5PONSIDI.I I'U;I ALL Ir:N'O)u•iATION WHICII <br />IS FURNISHED ON THE 1.PPLIC LION. ANY CI'A1cGES IN THE INF01:iIA?`ION, PLOT P12IN OR BUILIIING <br />PI A:4S SI7NLL BE SII`i MITTED TO TIM INSPECTION DIVISION FOR APPROVAL P,EFOPJ,. PROCEEDING <br />WITIl THE CONSTRUCTION WORK. <br />APPR(MM: <br />1. PI,APPNING ox Yti✓- _ DATE Ll 2i <br />2, ENGINEERING <br />TRAFFIC DIVISION <br />V/0171,11. S17P.VICIi _ — <br />SEVER SF.I:VICE <br />PUBLIC SERVICE SECTION <br />3. INSPECTION DEPARTMENT <br />4. FIRE AIARSHAT. <br />NOTE: ALL CONS'1'I'.Umoll Id01:1', SHALT, CO?il'LY WITH APPLICABLE CODES, NOTES ON DI:AWiI;CS, AND <br />INSPIiCTIONS <br />