1981, 03-20 Permit: 81A-2698 Inspect„APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
ZIP
PHONE
ZIP
TYPO qew N 0 KT. et AWN. 0 APL O MVL
G AERN O N.O. 0 psg 0 MEIN. 0 M.N. 0 POOL OTHER
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LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMeEAp/agl.,2—,2904
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ACILI•I S« a.Ck. M VM
North TL IaaeN /O
Sheet Parcel ,
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Or« O. 0 owe.
MppOpS, Arm In KIN.
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Main �Ms ra ItO4sper Plows IMAMIMAMNlefiex.eet LLW. MNmM11
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1
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1
ownership US
Pualle ON A
1 hereby certify trier I have teed and examined this eppllcetion end have read the "NOTICE" p,uvleions included
Ort MOM tide, and know the Hills to M true and correct. All provisions of laws and ordinances governing this
t.tyoe of work will M compiled with whether specified herein or not. The granting of a permit does not presume
Siva authority to violate or canal the provisions of any other state or local law regulating construction or the
no. of construction. EEE REVERSE SIDE FOR REQUIRED INSPECTIONS
APPLICATION 3-2A-8/ SIGNATURE OF APPLICANT
APPOOVM$ WEOIAL OONDITIOW:
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S uiNIM .#"1212.
Plumbing
Plan Check
S OPA
Montle Hares
Other (Specify
TOTAL
1 WHEN MACHINE VALIDATED IN TIIIS SPACE,