1980, 12-30 Permit: 80B-5090 Inspect PP
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I hereby certify that I have read and examined this application and have read the"NOTICE" i Eingb S
m side,and know the soma to be true and correct.All nces dons included
this
'•�peaof work will be compilednot.The
of laws Jn,l ordinances governing this RYIMIna
cancel
whether specified of herein el not T r granting of a ret does t presume
`� Rive ei,thority to violate or cancel the provisions of any other state or local law Ie I I the
r no
,I l:iliiu rnnsn uc nor
performance of construction.SEE REVERSE SIDE FOR REQUIRED INSPECTI IV5 PlumbinE
DATE OF APPLICATIO .__SIGNATURE OK APPLICA� FT' ___ 1 Mach,
SPECIAL APPROVALS SPECIAL CONDITIONS:
` NAME DATE Plan Check
' EL_Vl 0 ear NM I v 411... 2 ..
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Harm •
Mobil.Ha
Other(Speedy/) ns winTOTAL $ I t?L)
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INSPECTION RECORD
ADDRESS
DATE RSCS
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