Laserfiche WebLink
� <br />� �. <br />.�,yl�.,�� •r . . <br />; ��'� i .- . <br />v <br />CITY 0? E' RL'TT <br />DEPAR'Pt�,ENT OF CO�IDtUNITY DI;VELOPML,N'1' <br />• I3UILDSNG PEIL�II'P IPPLICATION <br />PERI�SIT N0. �� / � <br />� �y <br />VALUATION , /�O , <br />PERPIIT P�E ��, D� <br />A <br />Dr�TE %" < " � % <br />l� / �� <br />nDllRESS OF CONSTRUCTION WORK � � I �� r� ul /-�!'� ��'` � � �� ''� � — <br />LEGAL DP•.SCRIPTIOV : LOT W� 3 BLOCK _ P�T,�A �� �'2�� r� ��' �� <br />UNPLI�TTL•'D DESCRI2TION � ' -1 / - � <br />IIUILDING DESCRIPTIO:I: NE19 _, I�DDITION <br />,� OF' UNITS (�CCUPANCY OR USE _ <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: Y�S <br />CONTRF�CTOR <br />!•tAILING <br />ADDRESS <br />PHONE NUMBER <br />CONTRACTOR'S LICENSE tdUDiB�R <br />i <br />SIGNATURE �.'�� "� � � -- <br />`R�� f_OD L-• L� <br />OR REPAIR <br />STORIES <br />NO <br />0«N�R ./ G��L+P c �C'_,�J t�r%" ,`. <br />h1AILING , / <br />ADDRESS �G��`i/;CIKI��T!'�'� <br />PI�ONE NUrIBER �.3=_� %?` � <br />�OTE: THF•. APPLICANT SIiALL FILL IN ALL AIIOVG IILeINKS COD7Pi�TELY INCLUDiNG <br />THE PLOT P:,AN SiCETCH ON RPI�R Ol' iHIS SHEET. THE APPLICIINT IS RESPOI:SIBLE <br />POR ALL INPORDIP.TSON i41iICi1 IS FURNISIIL•'D ON TIIP APPLl'CA'PION. ANY CHAP:GES <br />IN THE Ii:I'OFLtlAiIO\, PLOT PLAN OR NUILDING PLANS SHALL BE SfBMI ED 7'1 TiiL <br />INSPECTION DIVtSIOii POR APPROVAL BliI'ORE PROCEEDING WITII THE/ NSTP.UCTION <br />WORK . ,_ <br />APPROV lL : <br />1. PLnNNI\G <br />2. ENGINL•'ERING <br />TF2AI•'FIC DIVISIO:] <br />�aa'PER SERVICE <br />SEP7ER srav�cE <br />PUIILIC SERVICE SBCT.T.ON <br />, . INSPECT�ijON DliPARTMENT �U� -�� ��_ <br />�" �L4,� <br />� <br />4. FIRE h1i1RSHAL <br />DATE <br />7� ..J-'7� <br />P]OTI:: ALL COP:STRUCTION h,'ORK SFiALL COhiPLY I9ITI1 APPLICA[3LL; COD�S, NOTES <br />ON DRAP;INGS, AND INSP�CTIONS <br />