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� ' ; ' ' ' DUILDIWG PEIU�tIT nl'PT.TCATIOt4 . • . • �� ':iCT,.�. �i " /: •:�* ��._.
<br /> - ' • ' . . � I�pplicant To Co:nplaCr_ Thi� L'orm , j � � �• / ' ,:• .i
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<br /> , • • If z+�rc than onc Uuilding is to bc com rucl•ed, submit n �eparatc pci-mii• applica= " '
<br /> . , tion for cach buil�iin7. �l separaec pcinit will bc isaucd f.or czch buil.diny. ,
<br /> . " • 6mcr (J 1� lluildinq Addre�s /-5'/�� : :/�-.- ,. /„ ��.
<br /> � , jifJdlCS'3 � C� C� I ty (' .T.OI: J . � L/ Jir N.•.
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<br /> � City Phone � ' Subdivzsion (P1aC) �� e 1��� 1': r.,, �jJ,�'t, �
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<br /> _ I�rehztect/�nginccr , ,
<br /> ' �� ''_� Ciky Phone .Id�tes L llounds (Unp1aL-ted) '
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<br /> � ;, Crnitractor � d /� C � ., s j .^,ec. Rw+P. IIge .
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<br /> - • . , �.ddre�� �'�f J/ ' /.>� f� =i %; S L; ' -
<br /> - •' ..City ��6 C rP ��f .Fl�une �3 �/ � 7G:�,� -73uildinq Usc /�vv c� (/�� ' � �' �
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<br /> � ��.� � Sb:te,Licca_e itc�ber ,�.�3 -u/.j,J '))� � Describe {7erk to IIe Done ��������
<br /> � - . .1 �iration Dat� � - U /- 7G I ' --
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<br /> . �� : . • ' , SI'S.TCII PLOT P7.n!i IIEL01'7' • 1+•: /��� ,r� � L" !�� 1 + . <. �I(�q�� >:..
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<br /> : 1 . oE lluildir.g
<br /> _�' � • � .�� � . , : - �liew [] A�dition Q Rcpair/Remo::el
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<br /> , � _ � � . • - 4aluation of Constructiwz S `d -
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<br /> . '� . , . . . . � . , -'PT/JT PLAtd R£QUIRL':�:ZTS . .
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<br /> . . � ' � ' ' . . ' � ' � • ' " : IndicaL-e lot szze, nv�e of: �trcet:, �
<br /> � �' ' � ' - � ' ' ' � •indicat-c location -ar.c �rictS o�
<br /> . ,. ! � . �, . � .: � . . � .alleps, 'localc nr.oposed �r.d a!1 � .
<br /> .. • ".� . _ � . � ' : . . - ' ' ..ezictiny .`,uilci:cs, sho•..,d�.s.anc._s .
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<br /> � 'a '- i:o psope,-�v lines, show disiancc�
<br /> . � . ' .q - bet�aecn building�.
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<br /> _ �y r:) �}� � 5� ' I�ot cize x
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<br /> , � ' _ 1i _ • , Lot arca � ,y. PL-.
<br /> • ,;. - l^�� �� �. u� • � . . -Siac of IIlr.g. � Sa. Ft.
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<br /> + •� ,�',t��" • .�-{• � liumUe: of titorar_s �
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<br /> . . For. �
<br /> . . .' . . • Ucuncr Phaic ',-5�l • -54-�.-'
<br /> . • DO 7d0: S�:2IT: 3EL0:7 .19II5 LI:Ji:-�OR �7I7'Y l)S2i O:iI�Y � - .
<br /> . nate `:cccived � ' a( -� r � u�e� 7.one � '
<br /> � ' PJan C:�eel: ::u-bc_• ' ' Pirr. Zo�c ' �
<br /> . \'a2ua`.ion �_ � Oc.r,tronncy Group __
<br /> :'i�init: I'ec --. — 5y�e of Con:;tivct:S.c�n �
<br /> 1'1.cn Cl�ecl; '-'cc `.__ � `� Occu��ant T.oad � ---- --.—_-
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