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C?TY CF �."',1:T: <br />➢UILDINa PLOT 1�Lk'1 <br />Lot No. %�� ')— Blk. N�. �`f" � Zcne Yo <br />Addition � e.'�1� c.T� � f� ��D�1'r 4ii'�, <br />Unplatted Description <br />Size of Builciin� �7� Z� x <br />Height in Stories <br />L�t Sizr� � ;5 x ���' <br />, � , Street <br />��� <br />Basem�nt '�'�W Occupancy �',n,�; i. I��.�,,". � <br />Ocmer _ S��1���Lw fl.+� Contractor �ju�a ,� 72u�� <br />Date � Z`— " 6`L Perrtit No. '� � <br />Remarks <br />Signature � <br />��(M,CCiwt 4-C^�. <br />rner <br />