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<br /> -�' ���t� bate Receive8 s L��/?'_�1 ? .
<br /> ,,�:% Total Pees $ c1
<br /> �` Date ApFroved: �a��7"g9
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<br /> ;<-"hntered By: � - permit#: � ��5 b
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<br /> '��� " '• REVIEM 1fILL B8 8'!AR?�
<br /> `;r�"�.L I]RFORI�VI'PI011 MII�ST BB SIIBMZTTED IN FIIL'I� BEFORE FI.�H ,
<br /> � � �ppylCNlfT IS= (circle�one) OWNER or CONTRACTOR
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<br /> ��, • twork)330-�'181
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<br /> �v ;� � =s � „- � PHONB:(home)
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<br /> CppTItACTOR: "'�n.•• — -
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<br /> ��►ILING,ADDRESS:
<br /> CITY: ZIP:
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<br /> ��� �F :�pgx= N� Addition Accessory Structure Move .
<br /> 1 ��eA�'. : :.Remodel/p.lterntion Renovate Land Alteration_�
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<br /> �$�I� O�I.II�'�"I� �eZClII�IIg IaIId�: $ _
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<br /> o b��`�apply,.for ..a buildinq:permit and I acknowl�dqe that the informatto�
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<br /> "���=�;,coatplete.:and accuzate= t�at the Work Mill be in conformancs �th,�hl'
<br /> '� �es��;itnd;#codea of'the City �nd �+ith the State Bni Iding Code;
<br /> ` lCx.t�his'is;,not a germit and rork is not to atart e+ithout a permit= anc',
<br /> � `e�iork itf 21�be in.accordance With the approved p lan. ;
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