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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 -'4c,-AN_Q • OA - 7' .19 -