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e <br />� <br />CITl Oi' ],:VERETT <br />DEYARI^•SI>'v'P 01' COl•i:•iUi�ITY llEVL'LOPiSEtv'P <br />13U7LDIPIG PE&"�SIT APS?LICATIO?1 <br />DA7'E �i � -- /(p _ � �;. <br />ADDRESS OP CONSTRUCTI0�7 F70R}C .i <br />LEGAL DESCRIPTIOi�: LOT �' % � <br />UNPLAT7'ED D;:SCRIPTION <br />IIUILDING DESCRIPTIOV: <br />�r OP UNITS <br />PERtdI7' N0. <br />VF�LUATION pD� �_ <br />PERI�IIT rL•'L•' '' • " y� pC� <br />' � /� �� r \ . .%'��J ` /� r• ' <br />/ <br />i <br />/���� � <br />/ �li..t._., Ji�/✓1J <br />r <br />BLOCK �� n_ PLAT ��n 'S � �- /-1 '�r� <br />NEW ADDITION <br />OCCUPANCY OR USE <br />IS THIS A CFIANG� OP IIUILDING OCCUPANCY: <br />CUNTRACTOR_� �, %f� .,!" ,. ` .-�`- v"��'' <br />I4AILING � � ' . <br />ADDRESS �%�� �ji ��. !/ .t',( , ,! ,' � c�- <br />�. ` . <br />' � �� — ;.= `=' � I <br />PHONE NUbfIIF.R ,i <br />CONTRIiCTOR' S LICEIQS�DiBER� <br />SIGNATURE � `''� � I <br />22Eh10DFL <br />OR REPAIR � <br />STORIES <br />YES NO/ �— <br />O�VN�R � , ,H •rI-•-'.r._�.l'._� <br />b1AILII�G%' � " <br />ADDRESS ✓ � ��-"� �✓� � �<-r. �s;, ( <br />� <br />PIION� NUMIIER <br />23 — �%— �� <br />� <br />�5����� <br />� <br />> :7 _ <br />NOT�: THB APPLICANT SI3ALL FILL IN ALI� AFiOVE 13LAI4RS COi�ll?LPTELY INCLUDING <br />TNS PLOT PLAN SKP,^tC}I OI� RP�IR OF 'PHIS S13EET. TIIE APPLICANT IS RLSPONSITILE <br />LOR ALL IC7I'ORh11�TION l';HICH IS FUR."IISIIED ON THE APPLICATION. ANY CHANGES <br />I.N THE Ii�rOR;dATI01�, PLOT PLAN OR BUILDING PLi+NS SHiiLL BE SUAtdI '7�T/P TO Tfili <br />INSPECT]:ON DIVISIO\ I'OR l�LPI20VAL BE}?ORE PROCBLllING l4ITi1 Tfl���l'i'RUCPIOi] <br />�90RK . / <br />APPROVAL: <br />1. PLANNING <br />2. ENGINliERING <br />TRAFFIC DIVISIUN <br />I9T,'PER SEP.VIC� <br />SI3P:ER SE]dVICE <br />PUIILIC SFRVICE SECTIUi� _ <br />.. INSYEC^1IUN DEPAR'PPIENT <br />9. I'IRG 1�iRRSHAL <br />UATE <br />1.OTH: ALL CONS7'ROCTI01� h:0i2i: SfiALL C0:•iPLY S'7I'PN APPLICAI�LE CODL.S, NOTL''S <br />0;1 Dl:�lt•;]1vGS, A;vll II';i'LC'1'IO:dS <br />