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MY OF EVERNIY PEIUIIT NO. i179 <br /> DI�MAIVINIMT OF CO:w1UNTT1' DEVIilA14 M g 7y <br /> BUILUING P11-MILT APPLICATION VALUATION <br /> P1ilU11T FIi6 o�O[ p <br /> ADDRESS OF CO)STUCTION WORK �. /'+7 �j <br /> LEGAL DESCRIPTION: LOT _l O BLOCK -- PLA 'get/, TAGS <br /> BNPLATTED DESCRIPTION: <br /> BUILDING DESCRIPTION: NW ADDITION of REPAIR <br /> uu ti 7,10 N <br /> OCCUPANCY OR USE HEIGHTS 1:1 &T@* •4 GNty <br /> IS THIS A CHA//NEE OF BUILDIxGG OCCUPANCY: YES • NO <br /> CONTRACTOR /�I 1 / Q. r OWNER e `l rY D74 2!/Z5 Zr 1;7- <br /> MAILING MAILING � <br /> ADDRESS '1`41 b loam rlfi ADDRESS <br /> PHONE NUMER (e b 4 a 3 Co PHONE NIMBER <br /> CONTMCTOR'S LICENSE L'U1BIF.R <br /> SIGNATURE � Q <br /> NOTE: THE APPLTCA,,T 511ALL FILL IN ALL ABOVE BL1s ::S CO?H'LEPL <br /> TELY INCLUDING THE OT PLAN <br /> SKETCH ON REAR OF 'P11I3 SHEET. THE APPLIC,S\T IS IU:SPOI:SIBLE FOR ALL INFOi'L'•TION WHICH <br /> IS FURNMIED Oil Ti1E AS'PT.ICATION. ANY C11AtlCCS I1l Tli:i IiqO*l.r,,ION, PLOT PJ---' OR EUILDING <br /> PLANS SHALL TIE SUMITCED TO Tk INSPECTIOa DIVISION FOR APPROVAL BEFORE PI: I:EDIFG <br /> WITH THE CONSTRUCTION ITOMIC. - <br /> APPROVAL: <br /> 1. PLANNING. DATE ?Y <br /> 2. ENGINEERING <br /> TRAFFIC DIVISION <br /> i WATER SEMICE <br /> SME11 S1:RVICE —' <br /> PUBLIC SI:RVICF. SECTION - <br /> 3. INSPECTION DEPARTMENT Ye� /•(/1:1 <br /> 4. FIRE MARSHAL <br /> NOTE: ALL CONSTI;UCTIOt1 WORT, SUALL CO?11!1.Y WITH APPLICABLE CODES, NOTES Oti DRAWINGS, AND <br /> INSPIiCTIONS <br />