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CITY OP L VI:Iti:r c <br />DEPhRT Ir;I,T 01' C:,}:'1U:::1'Y': UL:::Li;, <br />BUILDING PER;:]:a' <br />DATE Oct. 11.— <br />ADDRESS OF CO" <br />V.iLU.l7'ICiv----�---'-- <br />11X1.M1-: IT <br />.,..1,.uC1,.�n. <br />LEGAL DES RI �`-- C rTtc:1: LOT <br />UNPLATTED DL' C,;-P'i.TON <br />02 <br />BUILDING Dr.SCiJPT.iO:;: 1I13i4 "a_ ADDITION' REMOD:;L <br />'$ OF UNITS '— OR REPAIR <br />usi. in�le TGmilr��9l:lES <br />IS THIS A C11.-NGr, or Bu1LUIr1G OCcul,!NCy: Yr:, No <br />i CONTRACTOR ii i 11 i <br />MAILING <br />ADDRESS <br />PHONE 14U:•113ER �S — I1.; :, -- PHONE NUl•:'_:i?1i <br />CONTRACTOR'S <br />SIGNATURE <br />NOTE: TIIi' Ar-:'i,]:C,-sa'.i S'.il,:LC.O:•:PLIi'!'i'LY <br />THE PLOY' PLAT: <br />INCLUDii'G <br />FI';ii7C!I G` p �` •` <br />]FOR ALL I,1rp1<::' `.r! <br />i , P,'LICA ^ <br />10-: iCl;n,'7 <br />IN 'r11E 11v. CI.I,7.; o:!, <br />l Q'Lil;''Iuu. :!vs (..,i.NG1;S <br />r1G, , L;., <br />INSPECTION D1\ " <br />G , t : ,;i Ell/1L., li S'!:.'•..i :" ' iII CD i'0 ,!i <br />190RP.. <br />.�L;;U=I�G H_'il1 '!'illi COidSY'i<UCTIOIN <br />APPROVAL.- <br />1. PLANI:7NG <br />//70.'00'— <br />-- — <br />DATE. 40 7� <br />2. <br />ENGIN rit3 IC <br />TIZAVVIC— <br />WATER <br />PUBLIC !;]iitVlr;: <br />INSPECTION <br />NOTE: AI.I 014 <br />-- <br />;'iL'-. <br />