1981, 05-06 Permit: 81A-2136 InspectAPPLICANT' COMPLETE NUMBERED SPACES — PRESS IIAIID TO MAKE 3 COPIES
,Oe ADDRESS
1. f_ 12065 SOCIJG
LEGAL DESCRIPTION — SEE ATTACHED
wr ELOCic SUBOIVISION
2.
P NV
CEL M9ER/S OYPMl ,,,,,-v OF 01-a 3J
NR 12 PI / Vz rrr. 1.2.81' ! Gyauffyr.
D�yNER
IIIAPJ UPiRL AAPPT
PHONE
ALL •9'142
II'SM-nb7A-
a
ADUR S
E. 5 Y5OONI
ZIP
CAZOG
Actual Set a
North t=• acx1Souln 160' 4.5' 10.1 to
CONTRACTOR
SAyhe
PHONE
Sue of Parcel r ne.41.4lo40n
9'SxL1.5NG�41UDNE.DAW
y
•- ADDRESS
6161.6t
Z1v
pe't �
Iv -OOno.N❑
ve, Req..
DESIGNER
PHONE
n Balloting Area In Se. Ft.
Y•IttL SUP BAG
0 Sk
ADDRESS
ZIP
Garage stnr,P.
89�
CNAN.d OF USE FROM TO
o, Ack I Finished Basement nsln�=Wment
-
Il U
a
TYPE m NEW 0 ALT. 0 AWN. 0 RPL 0 MVE.
No. .`
9{1p5 fa*. StarNa
ROOM, No. of Dwellings
No. 2
'• OF WORN 0 SLD. 0 PLME. 0 MECH. 910.0. 0 POOL OTHER
CERTIFI ATE
1 EXEMPTION
Re Recd. ra✓ot ...d.
Dac0I•t WORK
a /tab . Mot Nowt Nome tWx64)
R. Lecavon 'Aran
FEES COLLECTED
Elnyl S
VALUATION SOURCE GAS ELECTRIC WATER SEWER,'USE
9, 11.560 UNSO.ITIES ?ev.4
COD[
PPdnc 0 Private Id
Building
I hereby Certify that I have read and examined (his application end haveAad the ' 401 ll . „ ncloderl
011 a a erste, and know the same to be true and collect All Ili-MO"iks '(if laws end 's governing this
type ofrwork will be conspired with whether specified herein •,i n „flw•granunq nl I I,••s n,, p es nn'
19 give authority to violate or cancel the loovlonns of any otllei siete or Inr.al law ii n, 0!/1 action ni the
performance of constructionSEEREVERSE SIDE FOR REQUIRE INSPECTIONS
fL1,oe
:''''
ycJ 1113.444r*:'''' G ��A" /I�,ePlumbing
OA FE OF AI•PLICATION 3 - 6- 8I SIONAI tIHIO .NI a..%A7 L. {���a/-1- T
Plan Check
SPECIAL APPROVALS
AME DATE
SPECIAL CONDITIONS:
SEPA
0niRao. ILowe. ERu'toC, we, Cns seri, TME
1e Ham. 0.0,„
•
Nal Iloo'D. hb&LE Nene REP -ACES P.Xt6-rin,4, Z 1.164rCON,+3Art,no4 Poo/.11.
Other1SPeerfy)
_1
,ales..
U3•
•900
•"00 6
*9008
A •000 B
21044
4 6479
07. •5000
•500A G
.50008
A •000 8
21354
03-06-81
4 6479
INSPECTION RECORD
ADDRESS
DATE
. 1/0 itva, /hE it&ise,
REMARKSrcL
• .7 (il% 4/4, ck (Li AG
zcntiO'ti)E, FO -5651
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