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u <br />cri�� o:' r;vcrr�rm <br />Di;r�r,r.•rr•�t::��r or co;•i:�iuN1_�rY ncvrr.oL,a�;rrr <br />r,uz�.,»�.;c r!;�::��r�r r�rri,ic,���c�o:� <br />�� �Y <br />DnTr % 7 <br />ADDRESS 0 CONSTRUCTIOPI �•70RIC ,l <br />LEGAL D�SCRIPTION: L07' <br />PL'Itbi].'P N0. _ / �� �✓' �O/�/ <br />,�� , oo . � <br />v��i,u,�Tzo:�� — � , <br />n�i::•,i�r rLL _ � " <br />3 �' - I � �;;��. <br />T3LOCY. PLA?' <br />UNPLRTTED D�SCRIPTIO;I f�Z_ �"� � U� ��, G�� c j- L 0 7` (% <br />> > <br />��0�-/�" L 1�•':i<7�' La {,�l C_'o (�1r� j}Cl�! <br />IIUILDING DESCRIPTIOiv: <br />;i Oi' UidIiS <br />Iv'ES�7 ADDIiIOIQ <br />OCCUPL':CY OR USE <br />R�610D � L• <br />OR REPAIR �- <br />STOFIES <br />IS TfIIS A CHAP:GE OF BUILDING OCCUPANCY: YES NO �� <br />CONTIZrlCTOR ���Cy� f,S. j/?u �i� C� N OS•]N�R %j U� <br />I•I71ILI�G b;AILING <br />ADD32ESS � Z- j'"3 3-3 l�f ��� ADDRESS <br />S%u f-f /f' (.�-.. - n p/ 1.�_ . <br />PIi0N33 NDb1BER �) L 3 %/ 3 3 <br />CONTRACTOR'S LI <br />SIGt�tlTiJR� <br />N�B� <br />PIIONE NOt�1II�R <br />� �3 �� � _ /003 <br />NOTE: THE APPLICAIdT SiiALL FILL I2d ALL ABOVE BIJ�P.i:S CO:•1YL!'„'"BLY IidCLUDI?:G <br />'i'I3�; FLOT PL:.:: Si:ETCiI C?C F:�lI2 OF THIS S?iL'.':T. TFiE APPLICAD?T IS R�SPO115IBI�E <br />POP I�LL It::'G;:_;^_ION i;?IICII IS FIIR:?IcHrp 0�? TEiE AYPTICATION. ANl CHtIIdGES <br />IN 1SIB INFOTt_•.A'iI0I�7, PLOT PLAN OR BUILDItiG PLANS SHALL BE SUI3b1I TED TO 't'::E <br />Ii:SP�CTIO:V DIVISIC:d I'OP. AI'PROVAL BF.FOi:E I7P,OCE�DIi: ,['7ITH TII.T•: C L'STRUCTI021 <br />WORK. <br />�: <br />APPFOV,aL: �' C <br />1. PLANNING <br />2. ENGINP•.�P.Iiv'G <br />TRi�rl•'IC DIVISLO�d <br />F7AT1:1: 5 �RV I Ci; <br />SEP:TR SEP.VICL' <br />D11TE <br />PUBLIC SEPVICE S :CT7CiI <br />'. Itv'SPECTIO,: DEPelRTt•IE�12' _ �� �_,� - %y- <br />� <br />9. T'IRE t6T�R531�1L <br />NOTii: AT,7, CC:C51'RUC'I'In1: (;0?:;: ;..:::i,i, CO';i'1�'i ;;I'PII APY7,ICi;iiLi: COi)?:S, ;:O'!'I:S <br />0:1 ll?L'„•�I':Gi;, ?.':P 7:!:tii'i:Cl']:Oi<C� <br />