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.. � .�_�.� �� ��.�.7V - .�v,_�.._�... _ —- . _ .. <br /> � �.,._ (�� �� <br /> . yo ' 42 f' Da�e Rece�vec: _ - > ' � <br /> . =� ' � / <br /> Date ��^-�ved: <br /> � �=ec By ��✓L`J pe=:,lit �P� <br /> AT`T, I:tgpR.*�.ATI'ON HIIST BB SIIBMIT^'ED IN FULZ B�O� PI�'N REVI�W W�� BS STAR�� <br /> '� AP�_T�iC��7'I' IS.--(c__�' A cae)----WNL--o= C�NT�.AC'�'OR <br /> � �i�1�f' lltr<;��t:rc`� �i-./' ._ ZSP:��._>.�� <br /> JOB SITE ADDRESS: (,�/- /r� - <br /> (wark) f�?�`���` ��� <br /> ; <br /> �.E OF OWNER: � /=h/Cc � �J't;� P30NE: (home ) �/`7C._//�= <br /> iSAII,ING F�DDRESS: �t" .�� 1%''�- <br /> CyTY: �'�L � :t�:-. � - � • Z IP- <<,S�C- <br /> ._— PRCNE: <br /> CONTRACTOR: <br /> :KAILING A.DDR�'SS: <br /> - - CITY; ZIP: _�.-- -- -- � <br /> Acc�sso�.-v St,�c�s�e Mcve <br /> �F OF WOR�: New �dci�_on - . <br /> DeTno Re**iodel/�lteration <br /> kenovate Lar.d A terat=on <br /> �D WORR (describe in detail) : ,�.��-= �' /-'�t'.GIG L,? 1�-�Jc/S�n^ � ' <br /> PROPOS ' <br /> n <br /> �� ��� ���� ��� �� ��. <br /> STORIES: SQ. F�T QF EACH FLCX7R= . <br /> I�IO. OF B�RO:.'�: Gi�RAG$ STAI+i+S: ATT. DET. <br /> ���'(: <br /> $STIFdATED COASTRIICTION VALIIa�TIOI� (eaclnding Iand) = $ d <br /> I hereby a�ply for a building permit and I acknowledge that the informatic <br /> above is complete and accurate; that the work will be in conformance with t�- <br /> ordinances and codes of the Cian Wo=k ishnot to st rtBwithout a F rmi haar. <br /> understand th�s is not a Ferait <br /> that the work wi11 be in accordance with the app�oved plaa. <br /> � - � -7_�� <br /> APPLICAF3T'S SIGNATURE: � ,1� t � � � DATE:,�_ <br /> (Pleas fill out the reverse side of this forat) <br /> 4 <br />