1980, 02-06 Permit: 79-7269 Inspect_ � a
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR T OF WORK
N S E W FINAL INSPE ION:
DATE REMARKS:
DATE �
APPLICANT: COMPLETE NUMBERED SPACES - PFIESS HARD TO MAKE 4 COPIES 04
,oB ADOREss 3 y / LEGAL DESCRIPTION — SEE ATTACHED
PARCP.LNU Mil
Z.
MON!
OWNER
726H2
3' nP ap,. n «
ADDRESS
,nn
1 1-0
CONTRTR MON! Sla. of Parnl Zom CH•elllullon
Q
4' ADDRZIP v«Can.t, ccup•nq SprinFl.r.e
❑y.. Cilia❑ R.a'e.
D[[IGN[R, PNON[ lu•tlon Eu11Gln• At. In BR. FI. .
B' ADDRES r EV wAl. 16nm•n r u.e. r. once
CHANGE OF USE FROM TO Solt Entry- Spllt LPNI •ncmr
B.
Na
�/ No. Floor• No. Room. .c. Roam
TTIPE ❑ - ❑ AD'N. ❑ RPL. ❑ M
/]p\
7, CERTIFICATE R«'e.
C3 eLD. ❑ �:nG,. �MECH. ❑ M.H. ❑POOL 11 .T R
)(.EC.;
W.— j( of EXEMPTION
DESCRIBE WORN FEESCOLLECTED
N WATER f S
PYHgY dlal have rYen and ekamined Fhle eRoligaHRR and have FFad {hE 'INBTIP,€r' PFRYIYIRn1 111011ded
II¢IabY
r� rsl sr,le, ui rd knuw' the same [o be true and c rnet. All prov lion• of laws andGrdinanpls pov[INlne Ihls egaeing
rave
mulled with whethtt specified here n nr not The grentinR of :I permit does not presume
ugNe ur . I�lulr. nr cal Ilre provisions of any other state of Iocai law reptdating construction or the Plumbing
i. nt rnn.r �n Irr rrl_
Untnrr:nlrri
SIGNATURE _. Mach.
SPECIAL APPROVALS
REG'D. EC'D,
SPECIAL CONDITIONS: PI•nCh—
SEPA
Enr, H«Ith
FUnnlna
'
Will, Ham.
otha IEa•aiNl
,.
Fv. Mam.II
co. ingm«r
Pb
TOTAL
utulu.a
WHEN M4CHINE VALIDATED
THIS RECOMEEA YERMII
ion. Clearance - -
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