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f _ . <br /> f <br /> i <br />� <br /> h <br />� <br />` <br />� <br /> n <br />� - . <br /> i crr� or• rv>>i,rTT PliIL�fIT No. <br />� Dl'1'AI?T:41;t4'P OF CODI:IUNI7'Y DEVELOYMENT <br /> }}USLllItiG PJ?I�IIIT i�PPL]'Ci'.TION VALUATION <br /> DI�TE C� PE1::�1IT FliE ' � , Oo <br /> l�'i�%�% <br /> T <br /> ADDRESS OP CONSTRUCTION WORIC /G-/C- JIiN � �l ,' d . c' • • i ( �-�� t <br /> - . — <br /> :.rGAL DESCI2II'TION: LOT IiLOCK PLAT <br /> UNPLATTED D�SCRIPTION , <br /> / R�410D EL <br /> IIUILDING DESCRIPTION: NEW ADDITION OR 12EPAZR "x, <br /> i} OI' U:7ITS J OCCUPA\CY OR USE ��;.g STORIES � <br /> IS THIS A CIiANGE OF I3UILDING OCCUPANCY: YES NO X <br /> r— <br /> CONTRACTOR n1�� v �"'. r rv;l :t . <"„ I ti'-. OS�7NER /�L�/� <br /> t�1AILItiG � hi7�ILING ` <br /> �r „ <br /> P.DDRESS �2.j `l.Z '1 '—_5% '-l.i<�. S � ADDRESS tin�rriv i>I.�. ,�-c"- : �.:: , ; ;'i <br /> • v � <br /> �i)r. �� ��> ., , 1 �c (11^S �� `i�� �'�'72_ .3: nillr. u� . -,� iG% <br /> PHONE NUDfIIEP. 5/,�j _ ;?,�, j,�,— PHONE NU^fBER "==•? .. �c��'�, <br /> CONTRACTOR'S LICEN. � NUh1BER .:c ;� 3 -p/ -• � j j � r, „,,... ��t . . _ �y/ <br /> SIGrATU � <br /> - �'.. r�� _ <br />� NOTE��THE APPLICANT SHALL FILL IN ALL ABOVE LF�I.I:S COAfPLI.TELY IP]CLUDING <br /> TI�B PLOT YL?.i1 Si:ETCll OD: R:AP. OF THIS SIIEPT. TI1E APPLICA?7'P IS RESP01•]SIBLE <br /> FOR ALL II:P0:2:L�,TIO�] 1V:iICH IS PURt]IStIF.D ON THE AYPLICATIOt�. ANY CH��I2GE5 <br /> IN TFIE IfiFOR?fAiION, ,PLO^1 PLAN OR BUILDING PLANS SHALL BI: SUIIhfITTLD '1'O TII� <br /> ItdSPECTION DIVISION POR APPROGAL BEFOi:P PROCEL•'DING �9ITH TIiE CONSTRUCTION <br /> WORK. /� <br /> APPP.OVAL: �G ✓• <br />, 1. PLANNING DAT� <br />� . — <br /> 2. ENGINT•,�FING <br /> TI2I�PPIC DIV]:SiOid <br /> Y7ATli12 SERVICE <br /> SBWT:R SERVIC� <br /> PDIILIC SER��ICE SECTION <br /> _ . INSPLCTION DEFA12TP1ENT - <br /> 4 . FIRE I•irl]?SHAI, • <br /> NCl'PG: AT�T� CO?�S7'?:UC'1'IOP7 FIOP:: �i1ALL CO'i11I..] T?I791 APPLICA13I,li CODES � b:OTF:S <br /> OV DPv,I•IIiiC:;, A\D IIdtiPP.C'PIOPiS <br />