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<br />~'\n:'k~1LIC^'!~![OIT~ Fort. ]~l?Jl;rrIT <br /> <br />iC ['1'Y OF ZETJlIYJR:U11[',lj'"S <br />mH1LJlnn~G llllt1:1l"AR1fHEP,rf <br /> <br />0',1<1"" '5 M"" 1ft 11 c lie IJ-Lfl E t1 r;:Z /J /}/ ( , ""0''"_ZJ',:2- J .:?il <br />O!mER'S ADDI\E.SS J<f"Jt?/ - y# I;-V-E- ;;Z-Pltt..l J' J...J"7"C; <br />.1Or. ADDRES';.---it71;r &-,p-u.. !?t I/O ;Z4J/':fj JlrY/ <br />If. <br />LEGAL DESCI\T!THP7: UJi1r(S) <br /> <br />PARCEL I.D.~~ <br /> <br />RILOCK <br /> <br />O;2-~b -;2/.- O~/t? -OCJt' ()CJ - t'C/;2 t) <br /> <br />SUBDIVISI.G~.~ <br /> <br />E'ORK PRoroSf~D:~~r(",;: CV>:!1lstx:1!ct <br /> <br />on <br /> <br />_A[Rdition <br /> <br />_:\1 te-r.-;} t r: G,n <br /> <br />Hep3it~ <br /> <br />_In~t~ll <br /> <br />_Sj',[.fl <br /> <br />_1t~ove <br /> <br />_De~oli.~;h <br /> <br />EIWPOSF:D USE: Single P~,lEily <br /> <br />VCO-::';::7.P- n:: ioa 1. <br /> <br />_tit F <br /> <br />_~: of ~~~:.rttts <br /> <br />_NtH <br /> <br />_Iur.hns t:. <br /> <br />_S~.6D. !'(lo)! <br /> <br />Other <br /> <br />rmn.DING SIZE: <br /> <br />_Ecst';;lUc3nt & I 'ealtb Dcpartm:e1l1l.t Approval <br /> <br />I/O X !r2<(S" LSbfJ Square Fe;>;. <br /> <br />It) <br /> <br />Height <br /> <br />RESIDDiTIi\L: t\TIM:11 (2) PLOT I': .f~~llS Ii: (2) SETS OF mrrLDUiG FLt;,:iS &. (1) s~~r ENERGY FOrt-iS. H <br />GO:~ERCIAL: ATft,(:H en SETS 0: !mn,JIH!IlG PU\~~S; ,!i; 0) SET E:n:EGY FnH-'!S ."~ <br />~~{:orl~ OF CDrrITHi\C~ HE~IQtl.JJlf1UID.. <br /> <br />Pf1:!R:ffilYS RElQm~.STEJ) <br /> <br />_ET~ECTRIG/\L <br /> <br />S <br />~'~1/} // <br /> <br />Valuat.ion of: Total Cm,stn:ct ion <br /> <br />_BUILDING <br /> <br />Mn' <br /> <br />~ .~.. <br />."en'JLce <br /> <br />Flori ~b PO"..;" J[ <br /> <br />CDrp.. <br /> <br />\i.R.E.C. <br /> <br />_!'IEGHA1I.,"IGI\L <br /> <br />s <br /> <br />Vallln-'llltion of rledl.;:mjGd Ir,st81Jation <br /> <br />_PI.illffiING <br /> <br />G:\.S <br />(:;-.,.:. <br />~~l{'-'L ~ <br /> <br />ROOFDl'G <br />_FJ[<mJc ~ccl <br /> <br />SPECI-=\LTY <br /> <br />TI'1.'E OF CO?~STRl}CTIm~: <br /> <br />.other <br /> <br />VI'. <br /> <br />IS PRO.llEt:T IN FLfJm, 70;(:,' ,\r,\~-,,\': <br /> <br />v <br /> <br />FUnSlIED FLOQR r::LE\"~\TI:[mS: <br /> <br />YES NO <br /> <br />JJ...^- _..._ J._ _..~ oA" <br />_._.... ._K.... ,_ <br /> <br />.~*~~~~~~~~~*~*~~~*~**~****~~~*~~~*~ <br /> <br />ET.EGTRTGT AN orni1PAN'{ 01l~ ytl: C t5C712 / G.- <br />(&~' . St:..c'1ltc Ccrt. or ITegist. iJ' <br />~atnTe/J////~ " ;7_~ ,:.o,:"{_~_&:a~~~~~_~~_k~.~~~~~~,,:~::~i:.;:~~:.-~~:~~":~ i~ L 7-? <br /> <br />/ . <br /> <br />PUmRF:R corr:lfPM~Y CIII0!s. f!0).t,f( fJijjmbffiJ6 <br />/' /J ~~;j () f) /J St...':atc .~e.['t. or H.:,.';;;;. ~>. ~:~. ....;.'''. ' .-ooYiS"Y-8" <br />Si~at:~!!:'~ ~...f~~4 ~./l G--'_f'-::~ T~r<>~lS~ !~~g1~;!T:;>'~:'011 ;= --~ <br />~*~~~~. ~~~~~~~~~*~~~~~~~~~~*~~*~~~:~-~~~~~~~ <br /> <br /> <br />IC01NlTHAC'JrOR S~~.f;T'Tmi <br /> <br />Of}m'A~'JY . (C/f?ML#.~~~..J <br />SIt-<J\te Cera:. or !~(~gi:';L r;i ?Mf ~..;2~ <br />Ci<<:yI.iccnseRcg'isU-:.r.;: ion ;': :;tt j , <br /> <br />BUILDER <br /> <br />S j p,na tuee <br /> <br />~'~'~'11:'!l:'!:.. <br /> <br />~~~~~~~~~~~*~~~~~~*~~~**~~~~.~~~~~~~ <br /> <br />OTUF.'.R <br /> <br /> <br />~ mlifPMJiY ~?/LY~_/l;~L- <br />~ ,.... r ".., <br />. ""tate CC'c'_' 0._ "'(,.::':., ,.__~_,~~~,,&,~ <br />"'JL. tu T -; r-~n"c p ,,<,; ,. , .---\,; ""I -- ~ <br />\\... ,'j' .1i....Q.."'-_"-_ ~)', .,;, '.'i._ L';.t ~ J. ". .1. ".- ',--.~ '..- ,- ~.' <br />/ ,;,;.,:';!; '::".>;:~":". -. ,_..!:..!::.:~-.!:.:-S:-J1::-!I::.grf1::.~.~~-e.il.,-:;=:::=,~'-:;":::'R;...7::-;,"'::';7:{!,"f:; -.~..:':.;. :7.--::':".'.': .:': ".::';"'.: <br /> <br />m;cn,!\i;ITCiYL <br /> <br />Signatur <br /> <br />OOlJ'lWl\1iN <br /> <br />St.mt:e Gert. or Regi~;L !:i <br />Cj.tt)f I.."r...cc:asc l~PJ"~ ~~;; t j-;.t:7- ioa <br /> <br />Signature <br /> <br />J\.J.1-...r_.r, ..~ ~~, <br />.. -, .- ... ..~ _. <br /> <br />~~~~~~~~~~~~~~~~~~~~~~~*~~~ <br /> <br />."...~..,.~..,_"_."__.:o. ^ <br />_, ^' _. .h ,'. ., ._ <br /> <br />APPLIC1\TIO:;: APpr:::mT,n ITY <br /> <br />'7! O/M ~ .sIj.p\4~ or <br /> <br />l';:-;:~nT OFFICF.I~. <br />