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MY OF EVER iTT <br />DEPAIVIIIENT OF CO:MMITY DliVl-.'lQP "NT <br />BUILDING PERMIT APPLICATION <br />DATH <br />MIMI! No. <br />VALUATION <br />PERMIT FEE w O <br />ADDRESS OF CONSTUCTION WORK J,7Pt> U 1KGIN#t+ -hJk Gr- <br />_dCGw <br />I1 lisr+. <br />`1 <br />LEGAL DESCRIPTION: LOT 3 V BLOC), 3 P -00 PLAT t50teC 7 01 V U <br />UNPMTTED DESCRIPTION: <br />P.Isl10D1iL <br />BUILDING DESCRIPTION: IIE14 i !!DDITION of REPAIIt/MV <br />OCCUPANCY OR USE V1SiM15- To 13gSEM0 HEIGHTS IN STORIES_!�eN <br />IS TINS A CHAIME OF BUILDING OCCUPANCY: YES NO <br />CONTR'XTOR <br />HAILING <br />ADDRESS , <br />OWNER <br />MAILING <br />ADDRESS l7(�5 U! IeCIIN//i RUB ' F�IEQEii� <br />PHONE NUMBER PHONE'NIMBER 267, Vll S2- <br />CONTr4CTOR'S LICE' :UIJBER <br />SIGNATURE <br />TOTE: THE APPLICAIII' a'611 FILL IN ALL ADOVE BLAI:R:, C0:•IPLETrLY INCLUDING THE PLOT PIA•^.; <br />SKETCH ON REAR OF THIS SUEET. THE APPLICANT IS RESPONSIBLE POR ALL INFOP.LVTION WHICH <br />IS FwNI.SHED ON TM APPLICATION, ANY CHANCES IN THi INFORIMATION, PLOT PIJ,N OR P.UII.DING <br />PLANS S11iLL BE SUL fIT-ED TO Till: INSPECTIOA DIVISION FOR APPROI'AL BEFORE ING <br />WITH THE CONSTRUCTION WORK. <br />APPROVAL: <br />I. ruNNING. CL� DATE 3 —AY — 7 `f <br />2. ENGINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWL11 SliRVICE <br />PUBLIC SERVICE SL'C'ON <br />3. INSPECTION DEPARTIRiNT <br />4. FIRE MARSHAL <br />NOTE: ALT. CONSTRUCTION WORK SHALL COMPLY FIITII Al'1'LI.CABLE CODES, NOTES ON DMVINCS, AND <br />INSPEGfIONS <br />w <br />