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r � <br /> _ � <br /> r � <br /> APPLICATION FOR ee <br /> �°na`���° �ONSTRlJCT10N 0 <br /> e�rerett PERMIT <br /> DEFt of COMntUNItY DEVELOPnIEnT SERVICES <br /> CITY HALI:59-87�5 1 <br /> [VeREiT,w�aeim ��OMBINATION � BULLDING ❑A.ECHANICAL ❑PLUMBING PERMITNO. <br /> UN M Wl�UUNIb Ctl1 ` ZIP VIIONI � <br /> �h � �S?�I� �a,,_, ��,,:- �>c �-i= ��e�:� � t��.�c;.�,_� <br /> c�unc�oxn�e��ix un.uoxiss ai� zr o � <br /> . 3�y5BK•193Rf� <br /> cavuum.�u•c�ua .unenoaiss ' p / �% uir zm rHon[ unnsu <br /> � v °I I e�. M..� i'a...r�M- C�"Ze�G: 1�$Y/-70�d <br /> �A �S /JUIlNIb9 /lc � u� � c� t roi iase <br /> ��IIn1��llOVR�CIOR \UIl10DR155 <br /> � M�II�D[INI55 (Ih IIV PHOM1f IICENS[I � <br /> lYl��IIi\G(O.qR�C�OM <br /> l l65 01 N ORK <br /> ❑NE\v �ADDITION ❑ALTERATION ❑REPAIN ❑DEn10L1110N ❑FENCE ❑SIGN ❑GARAGE ❑BUIIDING ftELOGTION <br /> c�w+no�u���oac �U <br /> > o coo � . <br /> �,�,�a�,,,„�,�. � �Id o N�l'o e x�sTi N <br /> � � 5`tcYra� F ,v irts �l <br /> vxoros�nov o� nunni.c 1 HEREOY CERiIFY TFIAT I HAVE READ AND EXAMINED THIS AP- <br /> � � PLICA710N AND KhOW THE SAME TO 8E TRUE AND CORRECT ALL <br /> ucu msrtiruovoi vaor�ai�isno��u euux oa nn+n��ouxcorrnu PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF\VORK WILL 6E GOh1PLIED\VITH WHETHER SPECIFIED HEREIN <br /> io�__nuxe__or OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTNOR�TY i0 VIOUTE OR CANCEL THE PROVISIONS OF <br /> �NY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR iHE PERFORMANCE OF CONSTRUCTION. <br /> SICtiAll1N[OF CO�`A��A�RIZfD�GFNi OATE �/G/(y� <br /> ioxm��ciss��..J � ��� � ! b <br /> PWMBING M HANIUL <br /> NO. TYPE OF FI[7URE <br /> (EE NO. TYPE OF EQUIPMENT FEE <br /> \\'AifNCIOSkIII011fll �IHCONp UtiIR-IIP fA <br /> REIHIGIR�tIOrv UNIIS-MP EA <br /> IlAl111UB <br /> UV'AIORI IWASH OASINI OOII[PS-IIP 1� <br /> G�S I IRFU�C Uh�15-IONN�Gk [A <br /> SHONIN <br /> 6RCHIN SItiF A I)ISP !ON[I U MR S\S1U�S-li T U ���� <br /> N'AIIHIAiINS-NLU AI <br /> OISW�SNfN <br /> IAU�tiDXf1RnP <br /> UNIIHUIINS-ItiU M <br /> QOI��I S N'�SMI H I\'nFORAtI\9 COOI(NS <br /> \VAII N Nf A1 f N (lO���f 5 ONYf H$ <br /> \'lNllUilOrv I�N <br /> URlunl <br /> DM1vRItiL iOUNI�IN RANGI IIOOD <br /> IIOON ONAIn AIR IUM1UIING UMI- C f M <br /> \'ACUUM 11H1 AAI RS SI O\'1 <br /> XOOf ONeIN1-RAI!:IUUINS MIUL iINIPUC! A UIIMNE\ <br /> SW�:ISIH\9(F-PAR I1C1 <br /> SU�TOT�I � <br /> SU�TOTAI <br /> IF�MII f �ElMIT S <br /> TO7AllFE 3 TOIAIfEF f <br /> PIAN CHICK FEE <br /> SlplYnRt)51 �fN SIN[[151iP K RInN�1,A/NJl nf111nCA PIArvOII/�f M1UM1�O[N Ftfq J3 R[CEIPTNO. <br /> /v � /� " /"' g�j /�/ y`37 /� — k(.� 7 Q'oZ <br /> US! ].O�ti LOl ARIA VAC�NT Slil ' f[[S V�W�/ION iEE <br /> G� ,2 nris �yo <br /> TYPf Of CUN51 OCNPAM1Ci GNOUP M1O 01 UW(IIING UNI15 <br /> �j-- I {+12 AVDN 132 — uuuoinr, S�� � <br /> S12[0111LOG NO OF STORI[S M1��X OCC IO�D <br /> Avr�AJ 15�-0 �.F I — rwn+xu+c <br /> L ilNl 7.0 �l OASlMINI flIUNOOn14 IINf SPNINAIIMS � <br /> XIQWNI�D/ MIOIANIUL <br /> _ -- — �1Y15 I�rv[1 <br /> AII�OVA'S ■Y O�l[ OiNIN <br /> 1 [HVIHONn11N1ALCMtIXl6T pIHnU\ UflC <br /> SIC JOHa� <br /> i nuiunnr,runs / A �� Q� <br /> TOTAL �KJ <br /> J IINI IIYURANi <br /> � flkl l'RO1fCiICNSY5ILM �[IIMITVAUD�TION J <br /> WHW PNOP(0.LY VALIDAI[UpN i1115 SPACq IMI$IS YOUR PLRMIT <br /> 5 GRApInpiEUVAiIONbCIURINGIGRUPflML <br /> G ORAINAGE <br /> ] EN\IFOrvMENiALIMP�CT STAT[MENT <br /> � MUUM UISiRICI <br /> APPLIU110N ACC 9Y iUNS CHLCKLD 9Y APPR fON ISSUANCI Fl� <br /> 'i," , G _ � � <br /> 1�,��P, <br /> q.t�;9 <br /> L J <br />