1981, 04-03 Permit: 81A-2448 InspectINSPECTION RECORD
ADDRSS
DATE
LEGAL DESCRIPTION — SEE ATTACHED
Zprw Class IuttoM
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Ole.. ONo 0 Rn'..
W I101ee AMP In Se. Ft.
AS 12
CIMegik00 USgi MOM
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TO
Un
INy.Itdtu, trni % Pa.,.
wLIT E a I ELECTRIC
1171 Ip
WATER SEWER
QEPTIL
No. Eat
No. Star 1p No. Rooms N
CERTIFICATE R.p a.
of EXEMPTION
[num. DIR. I Leasl.R I
Ownership USE CODE
Poen< O Private Ei
I hereby lia.v{y; Mat) have read and examined this application and have read the "NOTICE" provision. included
on arse sId.•'054.know the same to be true and correct. All provisions of laws and ordinances gove ing this
type of work w4+1 (9asplied with whether specified herein or not. The granting of a permit does not presume
to give authority tS'ylblite or cancel the provisions of any other state of local law regulating construction or the
performance of constiiictlon. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
TE OF APPLICATION" Ih. �92� SIGNATURE OF APPLI CAN T 5/1
L APPROVALS
SPECIAL CONDITIONS:
r
r
FEET COLLECTED
SINN E
EuikME
PIumbing
Maen.
Ran Check
SEPA
Mabe. Rom. �Ylry�
Other lSpeellE `�' i'_1L
TOTAL E
02• .2500
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