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FF'Of'L . i=�_�r;�_ept L.�.r,d.�_:�_,�pir,q F'HOflE FJO. . 4�� 4111=I T�_ir-�. 1=1�=� 1'�'��-� 11: �HP'1 P�� <br /> �� ! � vr vnv�vv � �+ ;�4r ,�w �v ua��a�yc i�. ap ;_}j . �C;V3 IYU: I�y <br /> 'I'OtAl F�K' � �. � `f� I3�te �cceived: -- ----- <br /> k'.nt�rtd By; ..._�G.�L. ���sit�+: _ �DC�oa � <br /> Cx��'Y 4F (�RONfl - �'[�DIl�� �'E�T A.�'PLICATTOrI <br /> All [r�form�ilon �nust be submitted €n f�aA b�focQ �pl�m rovlew will �Q started_ <br /> �rlr�s�print ali tr�for�r�vn) <br /> '�� APF7..�CAN'I' I5: (circle dnz) ONN��t Ok� G4N7RAG"TdR - <br /> S4B S�TE ADD�B�: ���1� c�.,,,�---, ZIPt s s��� <br /> NANIE 4F Q��I�I��t: �Q+�, �7,.h. �. _ �I30NE; (�am�) <br /> (wark} <br /> 141A.'��l'GA�?DRFSS: ��_--- --- CI!'Y: Z�: <br /> �i��'�.GT4R: Cn-�c _a 1�a,,.&,s�.�...�'� p�o:V'Es �4`� � -�. ,� � <br /> CCINTACT'I'ER,SON': ��.r,� -- mry ;`�—�—M $�.aEfPAGrER: o -- 3 <br /> MAII,��h1�A]�I?�SS: � � c� �'r;�.�� 1-.��...� ��'I'Y: r�lo,.�,�6�_ Z`�': �.s� <br /> S'�A'I"� LIGF.iv��: # P 4 4 � � <br /> A�t.C�l"I'E�'�'f�;�TG�IlV�E�t: ��IONF: <br /> 3v�ATI.Il��ADDRESS: ---- �ITY: ZIl': _,__.__,�__ <br /> N A�: ���G�'�tATI(?�I# <br /> TX�E ��'�i'ID�: Now Addit��n Acctsa�ry S�ucttiu� y <br /> ��ove - ----�-�Lemockell.A.lteretlnn ---- � Lax�d A]terativ� � <br /> ... {7 \0.�..�n�-Grn o�.�--�c.�r�y �-'--C'� K�D P.�J� �1�- , <br /> pRO�asEr��wvo�(des�n�� in�era��: R� � ���-� ���• � �^-� t�-&� <br /> �� ,.-4,1�. �•.�,.nn�,�. a�.f �' <br /> STCIRI��: � 3Q, k'��T OF EAGH�'�•4�R,t ' <br /> NU, a�' B��RE��MS: �AR,a►►,G� ST'A�LS: A."TT. �, DET. ----- � a +��, <br /> � Z o o a , o,a. <br /> �'L'1�IATED C��TSfiFtUC'T���i'V'A�.U'ATIO�I(excluding land): �� # �s�o .�����'� <br /> -ra-FA•� � a-,I.S'o� ,o 0 <br /> I hereby app�y for s bu�di�zg pern1it �d d acxaAawledge that the ir�t"ormatton at�ave is cam�Iete and <br /> �ccurate; Chat t1a�wark witi be i.ti con�'drz�.flc�with the ord��s at�d codts of the City� a.n� wich <br /> the State ���lc���g Cade; thac I understand ct�s �s nat a pertr�.i� �.nd wark %s �ot t0 Sfari withaut a <br /> �ermit; and ttiat the work will�tae ��c�arda.zuce wit�z the approvcd �lan. <br /> APPL�CANT'S S��NA,�'UE�: �i�m-�a-- � �•-�-� �JA'�s � � � -`�� <br /> ���,�� ����'�1'nmes even�s ra�irs separate p�ermzt appra�yal by Iaol�ce Depamnent and <br /> �"�ty C�unc�Y 60 days prdor to ihs event. Non permitted events wiJl r�tr�bt aIdow�d- <br />