1980, 09-08 Permit: 80-9787 Inspection CardINSPECTION RECORD
OWNER
LOCATION
CONTRACTOR TYPE OF WORK
N S E W FINAL INSPECTION:
SET BACKS
DATE REMARKS:
1-,4•21-10
ADDRESS
JOB
I'I'LI(:AN I : LUMPLL I L NUMUtHLU SPAULS — VI(t;,S I IAHU I U MAKL J (;UI'ILS
AMA"— rye
OWNE"R
. l I M 1)1��,s AW s2l .I•l
ADDRESS
S 101 q A t 2oa2w flp .
PHONE oqp
9AA -Si14
ZIP
COf TRACTOR PHONE
AX nl Vq,l PLs /ws(itN G 772 %L.
S-33F H LILT Sri Cr1iA IDAeLA 21PR3A1'
DESIGNER PHO
LEGAL DESCRIPTION — SEE ATTACHED
PAREEL NUMBER,
cruel Sat Becker In Feet
NOrtn ISevtn
Size of Parcel
Valuation
CHANGE OF USE FRO
❑ NEW
7. Of
w 0 ❑B
qR D.
❑ ALT.
❑ PLMB.
la AWN. ❑ APL.
❑ MECH. ❑ M.H.
❑ *AVE.
❑ POOL
❑ OTHER
o. Bat
a.
4
a
UTILFIH6
SEW!
09i08 -80
CERTIFICATE
of EXEMPTION
DhL IL cat on IAr.a
USE Coo!
P„mle eD Privets ❑
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions Included
Dn reverse aide, .and know the same to be true and correct. All provisions of laws :mil ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
t0 give. authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
DATE OF APPLICATION___ .v l Xr__ SIGNATURE OF APPLICANTl1
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
�P apG7 L. 9 -9 8D
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
BI al !
Building
Plumbing ls.'_
Mech. .
Plan Chack
SEPA
Mobile Home
Other ISpoelfvt
TOTAL'.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10,944118;V 998.?9 •1'i.009 9 -
DATE ISSUED PERMIT NO TOTAL