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v , <br /> C1TY Oi' F:VI'P.T1'1' PliTL�4J.'P N0. �� � �� <br /> nr•.rr,!;���a�;:.��� OF C0:9?fU;d.T'PY DL\�IiLOPi�fENT ` - <br /> II1JII,DTIdG P1if:i4I'1' r+PPL7Ci.�IOin VALUiYPIOtd <br /> , , / Y�1L�IIT 1'liL _� <br /> DATE �j� -' / — � � <br /> �� � <br /> ADDRESS OP CONSTRUCTION S•70RIC � '� � � /" -J� �� � � <br /> LEGAL DESCRIPTION: LOT �' `> r� ="% f3LOCY. 5 � " PLAT �-�1. . ��' <br /> �, ', ' 1 ^i .� , � , <br /> UNPLATTF•.D DESCRIPTION V �"- �F � � � �L '�" ( = � <br /> �. <br /> � �.c'n. �:oc. -•� �w <br /> ' �-�.. �,. Ir"�'or� <br /> BUILDING DLSCRIPTION: NE{4 ADDITION Rr�'1JLSL�L i <br /> _ OR REPAIIY , * L t�- Ift� <br /> #' OI' UNITS OCCUPi�1CY OR USE n �� �%l!_-/' STORIES '� <br /> IS TF:IS A CHANGE OF BUILDING OCCUPANCY: YES I�O 1/ <br /> / //�� � �/, i <br /> CONTRACTOR I, rY�`�:�i '-� C�'�� OWNER %�r;'- : 9 t'� -, /"�cT: < .�p,^� <br /> r b17�ILING� <br /> I.AILING --, -� �,_ l_. <_ ADDRESS ��'%1' �"�•'� ��!�=-�t <br /> ADDRESS � J. �:s<.1 <br /> � <br /> G t` '�(� j ✓ / <br /> ��_. (� Fi��� � � - ' . <br /> PHONE NU:SBER �< L - / `� �/ PfIONE NUAfBER <br /> CONTRACTOR'S LICENS N ER 'G � ` % ., '� - '-' <br /> SIGNATUR� �,I ,I� �\ <br /> � <br /> NOTE: THE APPLICAI�'P SHALL FILL IN ALL ABOVE BLANKS COt•1PL�T13LY INCLUDNG <br /> TIiE PLOT PLi::I o'r:ETCII OS RrAR OF THIS SfIEST. TIIE APPLICAiI'P IS RESPONSI9LE <br /> FOR I�LL I:�F02_:.TION i•1I�ICA IS FUR?:ISHED ON THE APPLICATION. ANY CHr1hGES <br /> IN THE INcCR2dAiION, PLOT PLrIN OR BUILDING PLANS S[IALL B� SUIIDfITTED `PO THE <br /> INSPt,CTION DIVISIQ;1 FOR 11PPRO�AL BEr^OItE PROCEEDING [9ITH TIiE CONSTRUCTION <br /> WORK. . <br /> APPROVAL: <br /> 1. PLANNING DATE <br /> 2. �I�GIt�E�RING _ <br /> o TRi�rF2C DIVISi0i4 _ <br /> t•;ATLI2 SIiRVICE <br /> SEWER SERVICE <br /> PUI3LIC SERVIC� SECTION <br /> ?. INSPECTION DLPA12TD1ENT ' - <br /> 4 . I'IRli bi•IY.SllAL � -- <br /> NOTi:: T+T,L CO�:S7`i:UCiIOid 1';Oi::: S2i?.I,?� CO:��PI.1' k7I?']1 JIPPLICi.I3LE CODl:i � i•:OT:::� <br /> ON L`Ii?,19I'v�_',±, A::i) 1.^.SPi:C'PIO:i: <br />