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CI71' OF l:1'lil:li7"1' PERMIT NO. <br /> Dlil'AI'I:lial'1' OF CO:;rilltllTl' Uli\'I:LQPIII'N1' VAUTA'1'IQN �. <br /> liblual G 1'!'IL'i1T Al'I'LICATION <br /> 1'Ii1tI1IT FEE m o <br /> BATE _ ` <br /> ADDRESS OF CON" 1101tK <br /> i <br /> LEGAL, DESCRIPTION: LOT BLOCK PLAT <br /> UNPLATTED DGSCRII'TION: <br /> RENODHL <br /> BUILBING DE'SCRIP'TION: NEW ADDITION dr 1t,VAIR 4&11 �ti <br /> OCCUPANCY Oil USE R FSi nrIGHTS IN STORIES <br /> IS THIS A CHANGE OF BUILDIVG OCCUrAl,CY1: YES NO <br /> CONTRACTOR hT P. OWNER II' ��y�olac <br /> MAILING IIAILI14G <br /> ADDUSS <br /> ADDRESS <br /> P1107lE NumBER PI1ONE NUMBER <br /> CONTRACTOR'SLICIi :SENUISIER `� — �sz'3L —� <br /> SIGNATURE <br /> NOTE: THE APPLICkNT SHALL FILL IN ALL ABO E BLAIM1M CO:SPLPTE•T.Y INCLUDING Till' PLOT PLAN <br /> SKI'ltill 03 REAR OF 'f1115 Sl1EET. * TIIE APPLICANT IS Itl",'M:SIBLE 1'OR ALL INFOaI .':PION WUICII <br /> IS FUJI11I311E13 ON TIM 4VPLICAT'ION. ANY CHANGES IR Tli!i INFOlIMSTION, PLOT P '7 OR EUILDIRG <br /> PLANS SHALL. BE SUL:•IIVED TO Till; I14SPECTIO.4 DIVISIO:C i'OR APPROVAL BEF P 0 'EDING <br /> WITH TIIE CONSTRUCTION WORK. <br /> i <br /> APPROVAL: <br /> 1. PLANNING. DATE <br /> 2. ENCIN13ERING <br /> TRAFFIC DIVISION <br /> WATER S)'RV.ICE <br /> SEWER SERVICE -- <br /> PUBLIC SERVICE SECTION <br /> 3. INSPECTION DEPARTNI'NT <br /> 4. FIRE 1IARSHAL <br /> NOTI': ALL CONSTRUCTION WORK "HALL COMPLY WITH APPLICAME CODI'S, 170TES ON mAWINGS, AND <br /> INSPECTMRS <br />