1980, 05-01 Permit: 80-3114 Inspectt
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR TYPE OF WORK
N S E W FINAL INSPECTION:
ET BACKS
DATE REMARKS:
i o
2-2�r/
1 uM•E � /
APPLI
LEGAL DESCRIPTION — SEEATTACHED
ARD LN /3 a,r3—i9/!
2 R PFIONE 407 // 0LK .Z MICA PARK ADO
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CcYlTRACT R PHONE SRe of PRul Y � 29ne CNOI�1<erlef
4.02
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GYM ON.❑ Reese.
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ANO[ oP WE FEW— TO n
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TIM C{NEW C] ALT. ❑ AD -N. ❑ RPL O MVE No. Beme Na. Srplx
No. Rooms No. of Dwellings
i. BAR Gf •LD. ❑ PLM[. 0..... [3 M.N. O POOL OTHER CERTIFI ATE
ea a. -d.
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of EXEMPTION
• M Enum. DIR. cation tprnt
a
FEES COLLECTED
EOUgp/C[ OA6 EL CTRIC WAT[R KW OwmrM1P W[ COD[
LITIU PueR<OPrAwN
EINI S
I here y certify that I hwe reed and examined thls eppllcetlon and hove nod the "N01 ICE" provillonl included
govning thla
OR nvern Inde, and know the ume to he I— and Cornot. All provlllonl of levy end ordinance' er
type of work will be complied with whether NMWfled herein or not. The granting of a varm)t dose not prom.
EulMlle
to give euthorlty to violate or cancel the provisions of any other (tate or local sew inqulating conitruotlon or the
performance of constructlon. SEE REVERSE SIDE FOR REOUIRED INSPECTIONS
NembIN
DATE OF APPLICATION 4 -'Z -9e SIGNATURE OF APPLICANT
h.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAM! DATE
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Ren Check
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SEPA
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