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<br />. .n. ..... ..... . "'"... """"... <br /> <br />t. \,1\,1, <br />I <br /> <br />eI'1'Y . OF ZJIll'SmHII.l!9 Pi:1Uaf APPLIWION <br />5UIUlOlG DJlUIl'!WQ!' 1335 I- It. J~l1., n. 3311~ <br />113-710-0020 rax,I13-7'O-0021 <br />~ DAft UCl:1VIW <br />, PIIOIQ 00M"tAC"l' Iat ~ImMO ~J 3. - CJd. (p....99fe, S <br />/I t 1) . '_ ;, i IYJCY'V / CIf <br />OWER'S NAH2 lL\ ~-;!f'?L.;1, U.JI.Aru~.,1 PKONZ ~J.'=3~"75J';;J.. '/7q~ WCtt5nN <br />JOB ADDU..' (1'):)00 I ~I S+ I , <br />LEG,aJ. DESCRIPTIO>>!..!. ~ (. 5) ~(". , .LOCI( 'SOBOIVIBION ,2. ~h<Jr :: rt'(Z.e., <br />PUCZL ID t 0,')..- ,Z0 ~2./-n/q() '~l>t)S!6a.nrv nOM PRn!'~_\ <br />WORK PJtOPSZD, dREW COtIlITIWC1ION 0 ADDU'IOM OAL'rDATION ~AIR 0 nl8TALL <br /> <br />o SIGN <br /> <br />b NOVI <br /> <br />PROPOStD OSl::DSGL rI\MILY Olo/ELLINQ <br />o ~ERCIJ\L <br /> <br />OWULTIwr>>lILY <br />, 0 niOUSTIlIAL <br /> <br />o DRHOLIsa <br />0. or ONt'1'S <br />D SimlMIIlG POOL <br /> <br />o HOBIU ROM! <br />DOTHER <br /> <br />BOILOING SIZE <br /> <br />~ RE81'ADM · IIEALTIl l;li,ARl"ENT API'ROVA1,.. J ' <br />~rlftU2 I~ll J<-Je-. S,l'"l-e, 5 i'2e~ <br /> <br />SOOUI FOOTAGE HElGA'!' <br /> <br />oa'CIlU'rIOM or woax <br /> <br />USIOaTIAL, ATTACJI 121 PLOT' 'LU. , (2) IJ:Ti or aOILDnlG 'WS , (1) ftT &IlEMY FORMS. <br />~CIAL: A'l'TACJI (3) stTS or 'BOILDINQ 'WI' (1) SEt a1iMY I'OIUCS. <br />IF SIGH PERMIT OWLY l~l S~1S or J:NGlIlIElllD PW,'azoUIRID. <br />PROPERTY SURVEY lJ:Q01RJ:D roa ALL IlEW OOIlSTROCTlON. <br /> <br />PZma!rS JUl:QUESTJm <br /> <br />" <br />ANJI saVIO: <br /> <br />D h'09re.. Enuqy 0 <br /> <br />N.R.t.C. <br /> <br />VA-llA~ <br />~ J ",Do. 7:f <br /> <br />o BOrLDING <br />o tLECTI\ICAL <br />o PLGfBING <br />o MECHANICAL <br /> <br />, <br /> <br />VALDATIOM or to'UL CON8TkOCUON <br /> <br />, <br /> <br />VAtOATION OF NECllANCIAL INSTALLAfION <br />DouEl. <br /> <br />- <br /> <br />D GAS 0 ROOFING 0 BPECIAI.n <br /> <br />t"YPE or CON51llOC1IOO I 0 BLOCK <br />rINISRXO FLOOR ELEVATIONS <br /> <br />o DAHl: <br /> <br />o S'1'&:EL <br /> <br />'OOTR&a <br /> <br />II ,PROJECt III I"LOOD ZONE MEAD YES 0 NO (' <br />, p.erep, A ~6N 'I CA + CAp;o JII <br /> <br />" <br /> <br /> <br />u.acnuCLUI <br /> <br />~ 0.00 <br />l5DWl7 .. <br /> <br />................................... 6-rR - CDu~ _ <br /> <br />CONPJUIY C .(e<~- IJ Ie_ <br />, , <br /> <br />SIGNA fUR&: <br /> <br />STA'l'I CElt OR REGrST f <br /> <br />..................**.**........................................... <br /> <br />naEU <br /> <br />SIGNA TUIU <br /> <br />CON~ANY' <br />STATE CEAT OR RKGISf f <br /> <br />~CAl. <br /> <br />. , <br />............................................................*..... <br /> <br />COMPANY , <br />STATE <:ERT OR REOIST t <br /> <br />SIGAAfORE <br /> <br />.*...............~......................**...~.!.....*........... <br /> <br />cma.Jt <br /> <br />OOHPI\NY <br /> <br />SIGNATOI\E <br /> <br />" <br /> <br />STATI CERT O~ ~GI81 t <br />