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<br /> C=ZY OI�'_ O1:Q;J0 — E4USI,UING FEZtM:LT AP.pL�CA�`:LON
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<br /> Tor:al �'ee : S ,�� , �' ' Data Received : '7 " ��- `i'/
<br /> /, Date Approved ;
<br /> �ntezed �y: �L�-�� _ _.. �
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<br /> Pe�mit� : �<'� '
<br /> 1�I.L IN$�R.MAT�023 HU�T BL SUf1MITfiED IN PsJLL PBPCfR.E �Y,AN 22BVS�1'rI i�1ILL $� $TART�1]
<br /> (See Check-off Li.s� Enctosad )' • '
<br /> T�E APP�ICANT�IS:� (air�le^dne } __QWNF_•R ax�CONTRAC�'OR----_�---------------------
<br /> JOB SZ'�'� �DDRESS t��,� ��"f/Gf�1//r/� ,7],t'/!�F lJ�C�/Y�CJ , ZIP: �j"�,���2,
<br /> �WOr}G) � ��.'-�'`�irlJ
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<br /> NAME OF dWNF.R: /�`�'i G� �',>',�"'�U is� cQU/.,.s'i�"` PHONE: (hom�s) �� -:�«��,�'
<br /> MAIL�NG ADDRF,SS: �,�,,3„� s'%�`pi?_,F,L/�/� f��� � �YTY= O�a�4/O ZYF! SS:.a�92
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<br /> CONTRACTOR: ��� l�• ✓�/,�L..�"��.-. �C✓/.f,l,�,�"',�c�1�` ..r'�t��. PHONF s ��'�-. A/ �`/
<br /> ' MAYLING ADDRESS s .�,j',j0 /!�• �F7�/Mr�7�/�►1 _�/�' :2TY:,�''��lZ,� l�/�`'4�' /�i�!2ZP� 3^.S—/2�i
<br /> 7.'X2�� Q�' WORK: NPw Additian � Accessory S��ucture Move
<br /> Demo� Remo e /Alteratiorf�� Renovate Land A tera�i�n ,
<br /> �ROpOSLD WO�C (d���ribe in deta.�l) :�GD �� S/� /�'I�.,t"o.liR� A�v� sT.��`�-
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<br /> /�1�l.�/7%e�A/ �✓/7'1� Sa/�'l�' JZ�,fNo,�FL !.�/aR.t /.bi .��lS T��t/G /�.�l�v � ,
<br /> 8�.'ORISS: � 3Q. $EET OF �CH FLOdl�: �O rJ� Sf ADOJTGif.�
<br /> N�?. 4�' $�:DRQQMS: G�I2AGE STT,LLS : ATT, pET.
<br /> $sTzr�.n�n CONSTI20CTION ��.a����zoN texcludi.n� �ana) - $ _ --�G�aa� _`"—
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<br /> I hereby appl.y fox a bu�. lding �erm�� �.nd 2 acknow�edga tha� the in.�ormation
<br /> abov� j.s compxete and aecuxa�e; �hat �}:� wnrk will be in C011LrOrM&27�GP with the
<br /> oxdin�nces and codes of ttie City anr� wi�h �he S�ate Building Cadej tha� z
<br /> under$�anc'i �his is no� a p�rmi� and work ia no� to star� without a permit; and
<br /> thxtt the work wilZ be in accordance with the approv�d pla�.
<br /> APPLICANT'S 3'LC;P]ATQRE� L��r�s0 /�,-r����u+,.--�_ bAZ`$i: ��f-�j'�
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<br /> .',rin ,',��'�. ',':'.t---,,T�� i il li�i'I�� _f0 .'.L 1� ��.i� ,i 1:T 7 T�-..�c?�
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