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T <br />CITY C!i' I'.Vi:RET'P <br />DSiYAItTL1E'vT OP COi•:>fU?dI':Y DliVIT.LOP:iPN'P <br />13UiLD1;�C PLiF2I'IIT APPLICATIO?I <br />DATE � � I ��� q�- <br />1�rRMIT I40. � d <br />VnLUATION �<� ��� O /'// <br />P�RIdIT FF.B . <br />ADDRESS OF CONSTRUCTION WOR;C �� I� � A�C� UYv� � <br />� 1�� , r�� � <br />LEGAL �J�SCRIYTION: LOT �/`�{ � IILOCK 1'LI�'P �7j } � [ 1.c (' �-�=«�1�' F' <br />— �J <br />UNPLATTED DESCRIPTION <br />REMODEL ���� 7« <br />IIUILDING DESCRIPTION: NEIa _ ADDITION OR REPAII2 OC,� ) <br /># OF UNITS OCCUPAIQCY 012 USE STORIES '� <br />IS THIS A CIiANGF. OF BUILDING OCCi1P7�NCY: YES __ NO <br />� ` \ <br />CONiP.ACTOR �� 4Eh�� � � �C��--�� OS4NER $ : ' � r v ,� Q_Q ( mt . � <br />IdAILIfG , MAILTrG � ����.y�� /� <br />I�DDRESS L1Ls ADDRESS ���` V L�'�.UYYLC�._S.,CI..� <br />�\S.0 �. Q_� � � .Y 4` IL . � U-�)�-�� �i- '�'O {� ' <br />PHONE NUidIIER <br />CONTRACTOR'-S—i <br />SIGNATURP� <br />�� �__ PHONE NUt•SIIER ���'" ���5 <br />E r:-ut•tn�tt �o?� -G 1- 1!-'/� �' <br />� �,�����r��J — <br />NOTE: T}3E APPLICANT SHAL':� �'iLL IN ALL ABOVE RLA4:KS COMPI.ETELY INCLUDItdG <br />TIiE PLOT PLAy SKB'iCll OI4 Ri'��P. OS TH1S SHEET. THE APPLICAivT IS RESPOi4SIIILE <br />FOR ALL INFORhLlTION S•;HICF3 Td PURNISHliD ON T13E APPLICATION. AT�Y CHANGES <br />IN TIiL II:F012:dATIU:d, PLOT PLAN OR SUILDI\G PLA.QS SHALL BE SiIIIMITTED TO THli <br />INSPECTION DIVISIC>] FOA A.i�PROVAL IIPFORE PROCEEDING �9IT13 THE CONSTRUCTION <br />WORK. <br />i � ^ ' <br />eIPPROV7�L: <br />1. PLANNING <br />2. E�GIt�EEP.ING <br />TRi+PFIC DIVISIOV <br />l�'ATER SEI2VIC� <br />SLS9ER SER�'iCE <br />PUBLIC SLRVICF. SHCTION ! <br />_ . INSPEC:ION DEPAR'P;•fEhT <br />9. FIRli ?ii�RSHAL <br />DATE <br />PdOTE: ALL CO:75TRUCTION Y;ORI: SIiALL CO>iPLY F77'P❑ APPLICAI3LE conr,s, NO'PES <br />O7d D22i+C�S?;GS. 7:��D I;�SPECTI0115 <br />