1980, 03-19 Permit: 80A-9784 InspectionVIJ1N tT0 1T� lest
a0E ADDNr
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APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL N„MBERES 754'¢- o -
Ree.ne 5 t Ba.l$eutn 51��
East IWest
ZiP
Sim X„1Z5
itt
one,.
DESIGNER
6. ADDRESS
PNON
iP
41OWLA,.'??Eles_ Area
❑v.e %so 0 owe.
aenAing. F .
Ar
torege
CHANGE OF USE FRO
6.
VA a 10 Purce
p• 70 UHlltlea
Salle ern, 1 SPllt Level
❑,/ ❑ ALT. 1dn0•N. ❑ RPL. ❑ LIVE. ❑ OTHER
H OLD. ❑ PLMB H: . ❑ MEC ❑ M.N. ❑ POOL
No. Bath
o. Floor
CERTIFICATE
of EXEMPTION
I hereby certify that I have read and examined this application and have lead the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All plovismons of laws and ordinances governing this
'type of work wIll''be complied with whether specified herein or not. The granting of a psi Mit does not presume
to give authority to violate or'Caneel the provisions of any other State local law regule ling construction or the
performance of construction.
DATE _ j�(,1i_�.)� SIGNATUR ✓_ /l•bkrere-re"-••••-••-("'
o. Room I Rec. Room
ee A. 1 ae e. rot nee a.
DEPT.
Env. Health
Nanning
Fire Harshen
Utilities
ompenTRIMPRIERN
SEPA Checklht
SPECIAL APPROVALS
RECD.
SPECIAL CONDITIONS.
h-r'k H ' Cis ferusa.lm
N1NL o000e-
FEES COLLECTED
Single
Building
Plumbing
Mech.
Alen Check
SEPA
Mobile Home
Other (Specify)
TOTAL S
TE
X6 AN�m97 �/
02• •5000
.5000 ti
•50005
•000 8
9722i
01 -02 .-80
s 6479.
•
WHEN MACHINE VALIDATED IN THIS SPACE.
ITHIS BECOMES PERMIT. / /����
INSPECTION RECORD
OWNER
LOCATION
CONTRACTOR TYPE OF WORK
N S E W
SET BACKS
FINAL INSPECTION:
DATE // REMARKS:
3 //9 l�10 f? r T.' f'oorik NOT _ de tow 9 -' e
_A S shown/ e N pAci �5=.
3.2q -9c 11;07`.;v6- de- "d 734c/r (J v /' To 9'e 7'
g