1981, 04-06 Permit: 81A-2504 Inspectll�
ADDRESS
OATS
INSPDCTICN RECORD
REMARKS
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8
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APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
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a
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
11/,..44$2.41,../5(tr�et..3. c,? -Zeal
ON
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ZIP
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Iu11EIne Arm In,Sg. Ft.
ADDRESS
CHANGE OF USE FROM
a
ZIP
Upper Floors 0111•90 .01
Storm.
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Arm of DAM,
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3/404 'UTIUTIEs
W NEW 0 ALT. AWN. 0 RPL
MVS.
0 SLD. 0 PLM[. 0 MECH. 0 M.H. 0 POOL
0 OTHER
Ho. Baths
No. Storlm
No. Rooms
No. of Dw.11ir,.
CERTIFICATE
of EXEMPTION
Rp'e.
R.<0d. rot .B'S.
Enurn. DIM
Lo«tIon (Arm(
OAS
ELECTRIC
watea
SEWER
Ow nor.o
Public 0 Private RI
USE CODE
I hereby certify that 1 have reed end examined this application and have read the "NOTICE" provisions included
Ss sltY, and...knpw:tha sn me to be true end correct. All provisions of laws and anal ces governing this
type of work w411N'94Mnplled with whether specified herein o, not. The granting o1 a pninlit does not presume
to Ewa authority in.vloljte or cancel the provisions of any other slate or local law regulating construction Or the
performance of con,t,Uotlon.SEE REVERSE SIDE FOR REQUIRED INSPECTIONSPlumbing
FEES COLLECTED
Singl. $
on 2011011, 47'—'
FATE OF APPLICATION.. —✓ 7-'S / SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS: PNI ns.<k
SIPA
AP-ehei 1<.1tw�'TEe/ WO.A aPA,P•::
FIr `� GSH-�l.YclL/4 NLI-� 4,4d4T0I — e r.o.1r, Lt
Mobil. Homo
ern«r /
Other (Specify)
cR
Ut
s [mallow
TOTAL IftSit
02. •4400
•5400
•54008
.000 8
[502[
03-18-81
6479.E *;
W 1 015 SPACE