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CITY 0^ I:VI:RI:I"1' <br />or DI:VI:LOMENT <br />BUILDING I'1:1 11T APPLICATION <br />DATH 13 AEI/, <br />ADDRESS OR CONS'11ICTION WORK S0 — C%/ sf <br />LI:CAT, DESCRIPTIO\: LOT o li1,OCl: <br />UNPIAT'T'ED DESCRIPTION: <br />PEIUIIT NO. <br />VALUATION <br />PERMLT 1'I:E <br />Z <br />rLAT�y�PI*SO��%nl/ �. <br />IU:1I0111:L <br />IIIIIT.UIi2C U1:SCRIP7'L0\: 1II1 _ U J ADDITION of REPAII( <br />OCCUPANCY <br />OR USE <br />IS TIIIS A <br />CIUwNCE <br />OP IIUILUII;C <br />OCCUPANCY: <br />CONTRACTOR <br />MAILING <br />ADDRESS <br />PHONE NUMBER <br />CONTTACTOR'S LICENSE NI;-MER <br />SIGNATURE <br />HEIGHTS IN STORIES <br />YES --L:L� NO // <br />ni ass �C9-9/�`l'Lllce <br />PIIONE NU11111311 53 — /,7Q <br />i <br />I/ --- <br />NOTE: THE APPLICANT SL4LL PILL IN ALL Almr Bmo tS :0:•IPLETELY INCLUDING THE' PLOT MAX <br />SKETCH ON 'REAR OV TIIIS 'MFET. THE APrIJcANT IS RESPO\SILIX I'M ALL INrO:UL•'.TION I.11ICll <br />IS PURINTSIIEU ON T1Ui API..IC4TION. ANY CHANCES IN TVF IYr01uL1TION, PLOT PLAN OR BUILDING <br />PLANS SIIALL 11% SULMITTLI) TO ME INSPECTION DIVISION' YOR APPROVAL BEFORE PIiOCEEDI:IC <br />WITH THE CONSTRUCTION W )RK. <br />APPROVAL: <br />i <br />I. PLASaNIL�'�-Ll� DATE: <br />2. ENCINEERINc <br />TRArrlc uTI'IsIOil <br />.• Wkrr1l cr.Rv1C1: <br />S1111:11 SERVICE <br />PUBLIC S1,1VICE SNCTIO' <br />3. INSPECTION DI:PAI:TIR:I,T <br />4, MW MARSHAL <br />NO'I'I:: ALL CO:;;S)'ItUCT'IO\ IlO1N1C SHALL COMPLY WITH APPLICABLE Col-l-ES, NOTES ON DRAININCS, AND <br />INSPECTIONS <br />H <br />