1981, 12-17 Permit: 81A-2623 InspectC
ADDRESS
IlVSPDCTICV RECORD J
DATE
P17 -V
REMARKS
%i plevt
JAPPLICANT COMI'LETE NUMBER En SPACES
JOE ADDRESS
LD R
2. 1 10
KAcit0--.
—1Rdsk- k a4MPn1
—e. Io --I I'%kIPSYIWv1
A "nI9 riI1
DESIGNER
5' ADDRESS
CHANGE OP USE FROM �TO
3.
PRESS 1 it'.1:Ta TO MAKE 3 COPIES
LEGAL DESCRIPTION — SEE ATTACHED
PHONE
Z6'1a337s
992_,"
PARCEL NUNSERh 09 547- 076¢
Nwtn I Ser Bac kisSwin m L'o tEaR IT befoul
:.?Seer 1169I:o A�t�•
#52-
Type Cana.
ocA ern e S rdna
Oyes Dos 0Roos.
Valuation
ZIP
AIOing Arm In Sp. Ft.
2—
Maln Floor 1 Upper Floere arm Area Storage
Arm of Dec s Finished lament nfIn. Neement
T NEW 0 ALT. 0 ADEN. 0 RFL. 0/Mot.
' 014.0. O PLM.. 0 MECH. 0 M.H. tl FOOL
WORN
,,. AI AyIE ° CI C ��L [Iv x��
VMFUA7 w161�cE aAf -I ILECTRIC WATER
9. 9' 44'42 UTILITIES
0 OTHER
N. .ams I No. Stew J No. Rooms IN. of OwonMes
Recd. 1 R441. filet Re✓M.
CERTIFICATE
of EXEMPTION
[num. OWL
Lomtlon (Arm,
SEWER
Ownennlp ral USE CODE
Public 0 Prleete
I netvby certify that I have read and eaen:lnerl Ih,r application and have reed the .01111('.1 " iir,rvislams Included
on mem side, end know the MIMI to ben a and wirer. All 4,1 0051011S
of laws end ,� nn,ner gov rnhng this
coer
type of work will be ...Plied with whethepecdled herein n t. The granting of ,� ., 0r,es nut pre
'r.,tra ave authority to violate or cancel the provisions of any .the, .Tare 01 kAallaw reyll! I , antructlon o„ lee
;:.(iaifprenance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
•
1 S OP,APPLICATION s�—/ 9- A CY � SIG NA I UTE 1)F APPLh;�R O.
iAPPROVALS SPECIAL CONDITIONS:
P113 COLLECTSO
Sing1
Building
Plumbing
/lr.,LYeh.
Pen Check
Mobile Nom
(SPeeif0
7L.
TOTAL $
.ER T NUM[tR
/A –.7.
•2500
.0`00
•25000
•ii00 0
' P8
03-20-81