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To: Building Permits Page 2 of 2 2017-03-22 18:33:58(GMT) 16512033584 From: Michael Benzinger <br /> • <br /> ����` �� ��°�i"�� <br /> BE�iB�d6�� ��rmit A���ic��i�n �'�r[Vi�in��ra�n��d Ftep6ace€�en'�/ R�rnac��� �-���i�l�r�ti�t:�J#��.Y <br /> �a.�� �a��4�ir��a��, d,r��:r�, �¢��;�,,, �a�-�;�c��, ��c�� ��� °�'f'��3�"��.��'fi�"�.� :�'����a�?�E�.��, <br /> '�`'� M�fJit) Addl�ss: � �� ��C1�` __7 <br /> �//��� W�� � � E�errtsiz numDAr; ,.�� �� <br /> t�0 Pi3l..oxoF - . ` - --- � <br /> , Crystal 5�,y,Ni�d�53�3-fiQfi�u ° 3�ate r�er,eivc�d: � �y � E <br /> � � h { Stt��t�Sr�c+ress.� � t2eeeived by� ___^___� <br /> �,\'� .1 m k 1' 275C3 Ks#�y Parkway ! 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TFy.��ppl�c2,ni reco�n#zes�h�at t,t��;y arc; � <br /> �o{ely res�nsebiQ for subm�ttir�c7 a carnp�.sFe applicailacr b�ing a}nraR�t)�a#upor�f�i#are t��o so,�e sta�f has iso aitemative but i� <br /> ! reje�:t it uniil it is corr�piete, <br /> � • 5�me or �fl 4f_thE infarmatian lhat �ou �re ask�:d ia prc�vrd�c��a� Ei7is a�:�l�caiir�a� �s clz�sifi�d by State law �s �ikts�� privaEe nr <br /> E <br /> confi�e�iial. Pri�lat�data is'sn�nrm�t(c�r���rhich,eneraify canr�ot kaa givsr�k�r rhe��ab{it,k�u#c.an b�;��v�r ta the srabject of fh�da�a. <br /> i �c�nfici�r#ial data is inf�rrnatar.�rr wlaic�gen�€a({y r.�n.not i��giv�n to eith�r t�� �uf�lc ur the subject qf tha data. �ur�urpose arRd , <br /> � intu refuse tt�s�fR;�f i4he infarm � {a�nnt�af6y t��ivai�our reGor'ds�n�!roc�rds of��hE�r c�raverrrmantaf�encias requirad by f�w. lf ; <br /> � s• <br /> �-...Y°.---- y �'....�. __ �_c�n,�4ie aP�l�c�t�on r�i�not be issued ..._.� `' <br /> f __�.. _,.......,�--_-----...._. -- <br /> f�'J....rx� � �,•' ,:y t { .' ^I_ <br /> ,�pplicant's Si�nstur�i, ��I �,. "' ` Uate: '�t���.-� / f 7 <br /> ' :�. <br /> f� e;. + ��...__ _ <br /> ���_.�� <br /> G�tn��'s Sig�aturt�: '_� �^'`��� ,...� C}ate, �w...y.. ..,.m..� <br /> Last Upda6ed:January 2076 <br />