1981 , 06-11 Permit: 81A-0961 Inspect INSPECTION RECORD
ADDRESS
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A ICAN • LETE NUMBERED SPACES—PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS OLS •1Q00
LEGAL DESCRIPTION—SEE ATTACHED
• I Ip .1000 G
LOT EL`N ISUEDIVISION PARCEL NUMBER/5 21r243-130,7
27..
"Nk(17aN 14 'E3*4-973-7 ,1-27—SI
ZIP ADv.)-A sf��w�ol°°'(1^ 9-39-o Ne.ln�'4�l Set �kIsoutn ri�i .R I I z lw.N ss In FM 6479
CONT R�ACTOR/III PHONE Sirs of Parcel ton.Aci `cClassification
'a ADDRESS ' ZIP '•f. en.L 7 H ❑v..�rNk❑R. •R �
DESIGNER PHONE Valuation alumina Area In Se.Ft.
6.
ADDRESS ZIP Won Flow Upper Floor. Garp.Area Stoma.
CHANGE OP DEE FROM TO Area of Dick. PIPINGS Easement Unlln.b.r.m.nl
a $0 NEW H/LT. 0 AD'N. 0 RPL. ❑MVE. Na.Ealn. I Na.Movies I no.Ream. Ne.el Dw.11lnW
T WORN LO. ❑PLME. 0 MECH. 0 MM. ❑POOL ❑OTHER CERTIFICATE J Reek]. Rica. Eio5'd. j-
el EXEMPTION II
a � YiWouJP - 1.1c( : ) Enum.Dub Location Wen) FEES COLLECTED
A.0 TION SOURCE GAS ELECTRIC WATER SEWER Ownership USE CODE
9. A-0° umlul ''
tES [(G Public°Privat.1
Single S
I hereby certify that I have read and examined this application and have laud the"NOTICE" ovisions included
on nide,and know the same to be true and correct.All provisions of laws and ooleoeloes governing this O. •
•
•
type ofr work will he complied with whether specified helein oi not.I he wanting nl i n noes not presume evading •
to give authority to violate or cancel the provisions of any other stale or local law I:onstluction or the
perfni mance of earWaruCtion.SEE
E REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
DATE OF APPLICAnlON/9/A(1- _Si Nnilllif Ill nPPLIl'n /-' � --��. Mph.
SPECIAL
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\\41411111H ECIAL APPROVALS nSPECIAL CONDITION
NAME,, i '�..1 ��
1Mi?Nn'f'-:.•.. Plan ONO P; ,,i 1.
Env HNIIP
ERA
Mobile Home
Other(Specify)
TOTAL S IO