25C-106 (8) I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 39
DEPT. FILE COPY
ZO
BUILDING
PERMIT VALIDATION
DATE UW-9 19 E(�RM NO.
ADDRESS a ^ P
6 J'
$utZ..Z> (NO.) (STREET) (CONTR'S LICENSE)
K112-0- f� NUMBER OF
PERMIT TO ' (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
n BETWEEN AND '...
n
(CROSS STREET) (CROSS STREET)
LOT
0
SUBDIVISION LOT BLOCK SIZE
i
3
J BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
a
D
2 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I /'r�', 7f ',�j��7 t� j p (TYPE)
0 REMARKS: [ A /!/LGG / <�G Pl+ga�
AREA OR PERMIT
VOLUME COST . ` � FEE $ •
(CUBIC/SQUARE FEET)
G 67
OWNER V
BUILDING DE da �C,�
ADDRESS 3� AD L7� & BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)