1981, 11-25 Permit: 81B-1997 Inspect INSPECTION RECORD
OWNER LOCATION
CONTRACTOR TYPE OF WORK
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4575
APPLICANT: COMPLETE NUMBERED SPACES—PRESS HARD TO MAKE 3 COPIES
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CERTIFICATE
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M EXEMPTION ®�
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UTIL TIf9 WATER owmaKK
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I hereby certify the) have teed end examined this Pune❑nn•ta❑
an rev r. N118,and know the same to be true end correct.Alt and have read the"NOTICE"provisions included Single $ 4,�F'
type m Work will be complied with whether s provisions of laws and perm.
governing this
to give authority to violate or cancel the pacified herein or not.The granting of a permit does not n or theme aYlalry
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perforn4rCe of:EDnetroetion.SEE REVERSE SIDE'FORions of eREQUIRED ny other tINSPECTIONS e or local law regulating construction or the
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DATE OF APPLICATION • SIGNATURE OF APPLICANT M P
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SPECIAL CONDITIONS. ENO. Z012..1_, �, I �
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WHEN MACHINE VALIDATED IN THIS SPACE