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<br /> < ' � �� '��1 h�lli��Par����a� � ❑Iirflou;���A( Dctcnr,inatinn} ,rm(���mpl��t�r� i
<br /> :��-��, ���� � t t,�ztal F3ai.,�1A'z, �> � �Tf/K/.
<br /> � ('� ��=J9-16UU f'�c(')i�����)-ah it; ' Appi<,���d Li�f If kcyuircd'c
<br /> C1T�' t)F fAFd(7�Nf� —5�,�1�'l:�t �S: ��'A7'F� / �ENERA[� F�RIi��t�'
<br /> (" .Aotc�S�nu���,ermiL may icyuirc appr���,il b�, thc tiuilding(�Ificirl anci rr I'uh1i��1'orF,.I?cpnnmcnt�°i
<br /> (-ll.l.PF:K:UiI ti- titac he tiubiecV to further r�erie�� vid mar not he i<+ued��I�en ihe inulirition i�recei�ed'�
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<br /> i CE'\'ERAL Ii\�FORti1�1TlOi\ --
<br /> I. l��ou mar a}�,�1�� inr utilit�°a�er7niu h�� nt.:il ��r ir pers��n nt ti3�Cit�� ��[1ice�.
<br /> ?. ��I��il�ci in applic:�tic�n;ari ;ubjcct t�� the}��,:ta�_e and handlin�, t�c sh��l�n helo��_ Pcr�uit�ar�ds v,�ill
<br /> l�e�ent h��returr niail ��ithin 2 bu.inc.;d���:.
<br /> ?. Perrnits �trc not ��xlid until��ott recei�e a per►tiit card.
<br /> -�. A1 nrk mu�t nnr hegin unle�s the p�nnit card i, a�ailaLile��n the joh>i:e.
<br /> J. l�tilit��c��nn�cu��n pennits ma��b. i.sued ti, I,censed�untract��r:onl��.
<br /> 6. (�cmtact thc f'ubiic ��'orks Departmcnt (`I`_'-'-�9--�600) for ut1lity�nib ac-built locauon�,.
<br /> I�C�ti0"F F�:XG��':�TE I7 :��1' STRE�T A\I3 i�0 7'O't�TAP�1N1� 11AI1� �vithout c�press
<br /> appro��al of the Yablic�V'orks Depai-tment. 1.>uarice of�a pern�it does n��t grant tl�i�apprc���al-
<br /> ,. :�11 ���ork must br donc. in accnrdan�e�+�ith Statr C�ode reyuir�ment�-
<br /> S. ��11���vrE: must bc iuspected betore ii i�co�cred. Call (9j?1 '_=l9-�#�UU. 24+hour ttofice required.
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<br /> Tl'PE OE= PER�IIT
<br /> (Check All Tliat A��ly) '
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<br /> ❑ Re��dential 1��1;i��1Zei�uu�App:�m�all ❑ Commerci:�l (Appr���al Requiriti)
<br /> ❑ 've��� C�.�nnectirn � AJditiu>>ai Coitnection Y" !Ze-Cnnnzcuoil ❑ Repair:� ❑ I)i�c��nnect
<br /> ❑ �1-at�r-A�-ail��hility Cc�nn�:ctiun I�ur Future Hool:-lip to 1Vater
<br /> TO� �ItC I U��'IIC:I' 7Si10t7l7tlllt)Il: �
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<br /> SItC �C�(jI�CJS: �� ;���i." ./ � '�"' :./t
<br /> O�+�n�i ,��, ..� Mailing Addi-ess: �' �� • �� .
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<br /> City: C_f'�,-�.�,_. . Z�P� — --
<br /> Home F'l�one: �Iternate Phonc:
<br /> Co�ltractoi- Infonnation: j
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<br /> Col�tract��r: �i ` r� _. Contact Person: `�--��' . � � -' -,T� -.
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<br /> Addr�Ss:�� �� �� L... �� State License n: � �.i c� ,
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<br /> City�: �-"� �-' : �_�__ L�}� -- --��� E�piration Date: � % �
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<br /> Phone� _ ` , . �- � ` ��lte?7�ate Pho��e: � ` �-
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