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,CITY• OF 1'VCRETT <br /> PERMIT NO. <br /> 0 PAP.TD11a." 01" COMMUNITY DEVELOPMENT - <br /> BUIT.UItIG PEW-11T APPLTCATION Vi.LUATION _ <br /> PE101IT FEE <br /> E ✓u/ _- P.G. _ SJ�i <br /> ADDRESS OF ONSTRUCTION WORK <br /> LEGAL DESCRIPTION: LOT // BLOCK " PLAT <br /> UNPLATTED DESCRIPTION <br /> REMODEL <br /> BUILDING DESCRIPTION: NEW _k:—" ADDITION OR REPAIR <br /> $ OF UNITS OCCUPANCY OR USE STORIES I <br /> IS THIS A CHANGE. OP BUILDING OCCUPANCY: YES NO <br /> CONTRACTOR <br /> 6WNER _,4 C/f <br /> % — ' `' <br /> MAILING MAILING <br /> ADDRESS ADDRESS <br /> PHONE NUMBER 1 PHONE NUMBER <br /> CONTRACTOR' S LICENSNUMBER <br /> SIGNATURE i +a <br /> I1 1 <br /> NOTE: THE APPLICANT SHALL FILL IN ALL ABOVE BLANKS COMPLETELY INCLUDING <br /> THE PLOT PLAN SKETCH ON REAR OF THIS SHEET. THE APPLICANT IS RESPONSIBLE <br /> FOR ALL INFOR14ATION WHICH IS FURNISHED ON THE APPLICATION. ANY CHANGES <br /> IN THE INFOW4ATIONr <br /> TPLAN OR BUILDING SHALL DSUBMITTED <br /> INSPECTIONDIVISIO14 FOR APPROVAL BEFOREPROCEEDINGWITHTHECONSTRUCTIONE <br /> WORK. , <br /> APPROVAL: <br /> DATE <br /> 1. PLANNING <br /> 2. ENGINEERING f �� <br /> TRAFFIC iI01 <br /> WATER SERVICE <br /> SEWER SERVICE <br /> PUBLIC SERVICE SECTI <br /> ?. INSPECTION DEPARTMENT P--7 4�— <br /> 4. FIRE MARSHAL <br /> NOTE: ALL CONSTRUCTION WORK SHALL COMPLY WITH APPLICABLE CODES, NOTES <br /> ON DRAWINGS, AND INSPECTIONS 2 PLUMBI.t/G J�'ISfl2 <br /> • 5H8/2T� ' <br />