1980, 08-05 Permit: 80-7623 InspectAPPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
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3. MDRE45/Yrl/4 240'NVYyJ
LEGAL DESCRIPTION - SEE ATTACHED
ADDRESSC /61zn
DtlI::• ADDRE98
PHONE
5,2 trtrA70
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ZIP
PHONE
ZIP
ICEL NUMBER/5
P Off5-6-2_D//J
orth40i615011t4s- I{est !West �S
slaoftreel (' 2 Zone Classification
1•
OcolpostY
SPrinklered
Dv.. ON* 0 R.c'd.
Be tion Building Arm In So. Ft.
J!
Mein Floor
52Xze
a r BareZ
Area Storage
CHANGE OF USE FROM
TO
Area of Decks
Finished Bamm.nt
Unfln. Basement
T. OF YPNEw 0 ALT.
WORN 0 OLD. 0 PLMS.
Ie WORe.a/
• A N(/f{O%�
9. 35± o
❑ AD'N. 0 RPL 0 PAVE.
0 MECH. 0 M.X. 0 POOL
0 OTHER
No
Baths
Nry'' P.M. Rae d. Stories No. Rooms � o. of rhinos
CERTIFICATEPfot yo'e.
of EXEMPTION I V
Enum. GUI.
URCE6. OAS
UTILITIES
QA
Location IArml
ELECTRIC IPk/P k,iWATER%
ER
Puollg OPrNate Si
use CODE
h
I hereby certify that I have reed end examined this application and the "NOTICE" provisions Included
reverseOn ln
side, and know the same to be true end correct All provisions of laws and nrdances governing this
type ofwork will be complied with whether specified herein or not. The granting of a pelrnit doer not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROV&L
NAME DATE
Env. Neer °
Planning
Fe. muesli
t o. Enalnmr
Utilities
SIGNATURE 00 APPLICANT
SPECIAL CONDITIONS:
3 .9VXET //Anrnvnc
By //fneTPV
ong
Sggp **sew.'
FEES COLLECTED
El gl S
Building
Plumbing
Mech.
Pl.n Check
SEPA
Mobile Home /66
Other ISPecihl
K
1'
TOTAL flea _
02* *10000
.10000
•100008
E *000 8
'7b 22
07-25'-80,
2 6479.
CHING VAI into -coin THIS_CPACE
e, vy,
INSPECTION RECORD
OWNER
LOCATION
CONTRACTOR
TYPE OF WORD
NSE W FINAL INSPECTION: ' EC_
SET BACKS
DATE
REMA KS:
•