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•CITY OF I:uRl:T9• <br />I)EVARIiENT.01 CW'WITTY Iil:'.'C1,01'ri%'N'1• <br />lslll).UiI;G PEP -MIT APPLICATIM <br />J DATE ,; /�S /J73 <br />_ ADDRESS Ol' CO:;STIiCCION WORK 'A <br />LEGAL DI:SCRIrno,,,: LOT _/ BLOCK <br />UNPLATIED DESCRII'PION: <br />BUILDING 1)ESCRII"1'IO:d: <br />OCCUPANCY OR USr <br />r'1'tI ADDITION <br />Pirram. N0, <br />VALUATION <br />PEI;1,1I•r rliE __•_____�- <br />PLAT_PiyA/f wmoN� iy/g r, P <br />IIEICHTS TV STORIES <br />IS THIS A CHANGE Or RUILDIBG OCCUPAl,CI•: YES <br />0i REPAIR <br />CONTRACTOR _,t/0pe__ Ja�;p �• E«�T- <br />MAILING OrINCR ;/O r%t cT <br />ADDRESS MAILIA'C <br />ADDRESS <br />PHU:IE NUiR;ER /UDI✓___ PHONE <br />CONTT4CTOR'S LICEN-l'. NU,,jiiER <br />V SIGNATURE <br />NOTM THE APPLICL::7' -SIALL PfL/-LL INN AALL•re11—I;OIT RL11,".i;i 'n: A' - SKETCH 0:1 REAR OF I'li1S SIIPEi'. I'UE APPL7C',.:'r IS IU;SI' G:ST.RLE I'0 TAI,LIIINFO',L,I'I06((T!ITCIt" <br />IS NUII'i!I; LL E '1'I!:: APILIC,1'C ill: ANY C1U,::LES IN T'Ia' I\.OR}L\T70:;, PLOT PJAN OR CI'I.L7.::G <br />PUNS SHALL BE SUL?IITI'1D TO ''III: INSl'EC1'10?! DIVISIO.. :Oil APPROVAL BEFORE I'IIOCEEI)IN.: <br />WITH 1'lIE COfszr,UCTfON FORK, <br />APPRO;'.4 L: <br />1, PLANNING. <br />2. ENG114VERTNC <br />TRArrIC DIVISiU;; <br />WATER SI:RV1(:C <br />SEVER, Sh)',VTCI-' <br />PUBLIC SI:RVTOr SI:CI'1 uV - <br />3. INSPECTION W.'MR11,11iNT <br />4• rIHN MRSHAL <br />DATE <br />NOTE: ALL CO::;;'I'Rl1Cl'1'0:! 11pPG SHALL C0:11'LY WITH AI'1'LICAI;LE COUh:S, IJOTES ON DRAWINGS, AND <br />:'1'] O::S <br />