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� , � <br /> d <br /> ' ca�r�� or T:�•r..Rr,2�1� nt:tt,ir�r No. <br /> ' nr•.r�v�.,�.,i!;;.�I` OF CO?1_�liJ?IITY D�l�:'LOP.4L':dT �L_ // �/7c! <br /> II071.,UlNG PI:i�1T'i` i�i'PLICi,'i�.0:: VALU;,TIO`: -!.�' U�-j' � <br /> PE1::�IIT FL•'E ' �,,2 .p�� <br /> Dl�ii: -%/�D/�� <br /> ADURI:SS OP CONSTRUCTIOi� �90RiC ��5// /•;1��- <br /> LEGAL DESCP.IPTIOiv: LG1' IILOCK PLAT , <br /> UNYLAT'PED DliSCRIPTI0i4 `/j�,,�� �4 c_, 2� —.�y _.s� <br /> � <br /> i _ . <br /> BUILDING DL.riCRIPTIO:.: P7ES•7 ADDI1I0:7 ���iODEL � <br /> OR REPAIR �/ <br /> �E OI' UNITS OCCUPA:�CY OR GSE f��.s STORIES / <br /> IS TIJIS A CHAt•:GE OP BUILDING OCCUPANCY: YES NO <br /> CONTRT�CTOR ��,r�n f O�7 T L�> _ +c�- OWNER f� U /�' � <br /> I�1FIILZ\G DuIILING <br /> ADDFtES5 /C' ?G 3 Gt�i�iar-�rn �'. ADDRESS � >� y,[ /�i�yc��z ��.t�� <br /> PHONE NUi•iBI;R �/�� ���/u y' PIjONE NU?•SIIER <br /> CONTRACTOR' S LICENSE NU?iBER 21Z� ^O/ '/.3fr=� 0 <br /> • uIGNrITURB � �r�. 1-% - <br /> NOT�: _TH • PLICAi�T SHi�LL FI L Ii: ALL ABOVE IILeli�i:u COhSPLETELY INCLU�I';G <br /> TIiG PI,OT P ::i; Si:i?�C:I Ci: Rii.-li2 OF Ti:IS Si:EET. TfIE APPLICAN'i' IS RESPONSI9LE <br /> 1'012 i�L i:l'0?'.:�'.iIO:; S::IIC?i IS Fli}2::IS:IED ON TH� Ai'PLICATIOid. ANY CHellwii� <br /> IN Ti ' IivP0I2�:�liIOti, PLO^_ PLAN O?2 BUILDING PLANS SHALL B� SUIIDfITTED TO TiiE <br /> INSPi:CTIO:� DIVISIO\ I'OR APPP.OVrIL B tORE PROCEEDIP:G SaITH TIIE CONSTRUCTION <br /> WORK. <br /> APPP.OVAL: � <br /> 1. PLANNING D11T� <br /> 2. ENGIiITEP.Ii4G <br /> TRi�1i'IC DIVISIO:v <br /> �•L1Tlil: SEP,VICE <br /> S�j•7ER SERVIC� <br /> PUBLIC SEPVICE SECTION <br /> '. TiQSPECTION DEPART.SP:IT - <br /> 9 . 3'I I2li 2•iAF:Sll�1L ' <br /> NOTIi: rl1,T� CO1d5Ti.UC:'=G:i S;GI::; ;i::,LL CO'iPLY �9I7'II APPLICA13LIi CODlS, Iv07':1� <br /> 0\ D]:i,P7I�di;S, T:1vD I:d:?i'i:CTl:O';: <br /> �1_� <br /> . � <br />