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� <br /> d � - <br /> CIT] OF i;VL'RL:TT PERASIT N0. <br /> � llEPAI?T:4L�I�'.I' OF C0:1i�]UNI'I'Y DG\�ELOPMENT VALUATIOi] --��t� <br /> BUII,UI::G, PP:RitIT i+PPLICi�TIO:: PtiPu�1IT b'EE �" <br /> _�DI�TIi /J �I ��� % 7` (•r � / <br /> AL�nR'.SS OP CONSTRUCTION WORK /�d� �///��yL !�� {� �7 J�ZQ'���/�1� � ' <br /> � � / �_ �� '. I <br /> LEGAL DESCP.IPTION: LOT -��=<.3-2'�` BLOCK � P�T ' �-�-"'�- ' '��' <br /> IiNPLATTED DESCRIPTION <br /> REI�fODEL � <br /> BUILDING DESCRIPTION: NE�1 ADDIlION OR REPAIR <br /> $' OF U.dI1S OCCUPANCY OR USE STORIES <br /> IS THIS A CHANG � OF BUILDING OCCUPANCY: YES NO � <br /> CONTRACTOR ., I � OWNER��G�` .-. • ' �����"� � -�'�� <br /> NI.4ILItiG .fAILII�vG /'� �. y ��J{ <br /> ADDRESS ADDRE�S Y <br /> � _ 2�_� � � _ <br /> PHONE NU6IBER PFiONE NUr1BER `� �9"'��`� / <br /> CONTRACTOR'S LICENSE NUDSBER <br /> �IGNATURE �� /f t�� � C/' ,rf � Z b^ �/ <br /> NOTE: THE APPLZCANT SHALL FILL IN ALL ABOVE BLANRS CO`rIPL.^.TELY INCLUDING <br /> TIiE PLOT PLi:D1 Sf.L1CII OV R?:��R OF THIS SFiEBT. TIIE APPLICA??T IS RESPONSIBLF. <br /> FOR ALL I:7FORi��=.'rl0id iti'ICH IS FUR�IISFIED ON TFIE APPLICATIOi�. ANY CHrl::GL%S <br /> IN THG INFOR•It1TI0?v, PLO^_ PLi�N OR BUILDING PLANS SHALL S� SUBMITTED TO THE <br /> INSPECTION DIVISIO:. FOR e1�PROV�'1L BErORE PROCEBDING I�ITH TIiE CONSTRUCTZON <br /> WORK. , <br /> APPROVAL: <br /> 1. PLANNING t *_,)' DATE �'��C —�y - <br /> 2. ENGINEEF.ING � <br /> TRr'�FFIC DIVISION <br /> WATER S�RVICE <br /> SES9ER SERVICE <br /> PUIILIC SF.P.�'ICfi SECTION <br /> ?. INSPECTION D�PelRTP1EL]T <br /> 9. rIRE P7�1F.SllAL <br /> NOTE: ALL CO�IS'PP.GC"iIO:i 1•:ORi: SFIi,LL CO:;PLY T�iITII 1�PPI,ICABL� CODliS , NOTrS <br /> ON Dl:AP7ING5, AtiD I^;SPc:CPI0:�5 <br /> . <br />