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Pines S 222 Valley Glass - Int Ext Rem E 7 / 7''_ (Y~D . (TH1S IS NOT A PERMIT) ~ BUILD{NG PERMIT APPLICATION WORKSHEET * PLEASE PR1NT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Buitding and Safety) ~ SHADED AREAS ARE FOR DEPARTMENTAL USE ~ Zoad . N►~nbW ~ mR 0 ~AC FIRST MI J Pb#act Addresf (Street Name & Number) Zip 6007N 222 414W~p Applicant r r 0Addrms 0.!~T 815 -0 CiN ~i_C7irC~V~i StateG~ ~ Zf `Ph," ~ 54~ ► ~02..~ - /~d G ~ Businesa Phone ~ ( } Contractor/Apent Addresa ~~~e~ GYt.~' ~~Rw~ s~~ 22z Piti0S ,er~ aiy State 1~ 2fp Phons 9MUC fiV gysoG (5j07) e~4q00 Contacx Licenae Number (Required) Businm Phone ( 1 /uchlted/EngIneer ' Addreas WWr 71.V /fEw c~ti siete zp Phone graC:lwgr Gil Of (got ) !cZ4 -11,06 cor►tad eusiness Pnone ~ ' ( 1 Lxlder ~ Address ~ ~ pty State Zip phone ( ) t • r i~: ,'7'`'~'~"~?`;~: :7~~='ya,~ .1.;~,j~;,; ~ Z• ,o ~ ~ : CWOm. ~~1YOW4V~~ - ~ ' • ~ "~yt-, r }r ' r '~r:,,'_ KR'M 4 ` ~.-P I Lot Blodc Plat Number . ` ' y"~~ , .►~.-:~,-r~. t ~Y• I . ~ ~0 a1. f, ~~'~e~ ' ~ 4~~~ Y ~ t... `-'t Ow~ .~r ~ . `y} ~ ~ . . ( , ' . . 7 ,'i f Y.'1. f ~r"'i~' ~ . : { , - . . , • . . . _ , - .~t'ti~~ r~l`~-~' i ~S . hL,. _ . . .,7~► r _ ~r`~.-"' ,j~ • ZAne Cwiws Tfaci - ~ ; • ~ ' ~ ~ Com Ptaii_ ~ 1 y ra• ~•ry►'~~}+'r:: - ' - ~i.11I:.....i.:..- ...r.... ~iltl~r►_ 4(8ultdlnq~- l.Ot Sim t3q. Ft./MMre) ~ . 4~ - DeptA Y~ Y ,a , Frqltwe 'r be~~~'~ s~!~] , tt.,: .t-~ ~s~'•~ °,s+. - _ _ r-~ L'• - ~ . :b~ ~ . ~ . ..c . _ - ,y ~ , .X. yr h- k ~~a,s.:. . ftht Aea=' R! W 1Mdth -'f ' . . ' , . ~~7'~ .,,I~" ~ ~►y`, .~R~t Y ~ _ . .+tt~ ~t'~~ ~ ~S~'~ . . . . ~ ~ • = r~w.~ .~s, r pN ~~r ~.f.~• ,r.w •.w'~!' ..i r~ y a ~7vc ~ s ~ - 0~ • , . . +~~ri4'~i-a~►.+_. ' ~ r ~ b ~ ~ _ . ~ ~ Y • ' f ~ ' ~ ~ ' ~ ~ .+M~~~~LMI~.~~ c • ~4[ ~ / ~ V , ,.~a . - • ^ -r.. ~l,. ► / r ~ ~a I+'.IFN~1 j~ . t ' . i : 'Y."ti ti,J 3►" 1 'Yt~.•~'~ j'^ .S•S'v-. . ♦ . ~ ~ iy' . y . . [ ' ' ~ . . ' y.~ - , • ` r . .L , = : ,S 1~~~'G~~~ Z :y'~o `'1 ' • ' . . ~t L r^ . . . 4 'L • ~a^ ~Z.~lfi„~.~. r ~ . ~,s•.... _ ~ , ' _ a.r O .i , . . } ti.~ 1-•~" .Ay' I' QAwrv',,►.'~:i`,~-- : : . ~ . . ta . '~r•~• f . '~3''. :r~ a +~/`-.•r - . ' ~ . ►<•~u-^ 'r -L_ - . ~ i r.? ~4,.?~!1 ~ ' - _ _ y . - .x... . . :.~f.-.. . ' , o ` `~k -i.:'. , ~ r'''''-. i: ~'~,~t~4'.~_ cc -+~7A✓.~ .,~'R .S _ . J . . _ ~ • It ,1 " , - 41. ~ ~ ~ , f M ' ~ " ~ ' . , ~ _ . . . y ~ ' t J . ' ' ~ L. . •'I a ~ ~ t~'~ 'x .ti.n, ~ , , ' . . ♦ r s=•-.~• ~ - . ~ 7w~, 1 ' ~~~~j~y y~ F ~'T ` . . ~ a 1 + ' . C~ ♦ . . ~ . . ~ • . . _ . `~7~ ~~`~2 ~K "y: t 'j ~ _ ~ "C• ~ "I } ~ ~ ~s ~l ..~.y~t Q ~ „ " ' . r . r f! J . .o ~i . ~ ' e •~L1 d+~T 4:. Ai►L ~."G r Z ~ ~ _ . ~ ,i: t'♦. _ ~ - ~ . 4. ~ . _ '.s. ~ 1 . . . , W-11 ._yA• ,J ' ~R ~ • . ~ . : a ; . w : m Phurnbera Bedroono ~`~n: e R'y~~►. ~~P'~~' -~+'.,~,?N •L t ` . '~a.~.~i~ +.r~, ~ ~~7 L ...-+r~. ~ , .f~.~ i~ ~'T.''i• ~'y~~►~~`♦'•~f~-1-s~1.'1~: . ~ ~ ~ . . _ .i~ . ! ~"!~A-~ ? .~J ~ '.G. . . . . . TaCttt►k[il~►-~:~' ~ ~;sal Ot~g.~ .~y•.i; 'i' . , fi:r~r '-.c. D TYPe ' ~ .4 07- ♦ 1 A ~ , ~ - s . ~ DEPARTMENTAL REVIEW Cond. ' , Approved qpproval • Hold I Enrfronmental Health Appllcatlon N ~ W. 1101 Colleqe Room 200 y ~ . ~ Plannlnp/Zoninp N. 721 Jetferson • ~ ~ Engins*n ~ N. 811 Jeiferaon Utilltlss ❑ N. 811 Jefferoon ~ ~ • Pfan Rwiew/Fln Pnwntbn ❑ N. 811 Jeiferson i' OUNr (SEPA/Cntksl Material/ste.) ~ ❑ I ❑ Fut Tra*/Spwlal Inspectlon informatlon "ect Representatlvs Phone Address ~ I certify that 1 have examtned thfg application and atate that the information contained in it and submitted by me or my apent to compile said application fs true and correct. ' Signature , Date ~