1981, 03-30 Permit: 81A-2826 Inspect INSPECTION RECORD
ADDRESS
DATE 11/22v
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APPLICANT: COMPLETE NUMBERS -PRESS HARD TO MAl(E 3 COPIES
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I hereby certify that I Save read and eximmed Mit application end have lead the"NOTICE"provisions Included ��,�((
on reveres side,end know the same to be true end correct.All provisions of laws EMI mlbnances governing this tulblng IY'
he
type of Work will conplIed.with whether speclfled herein or donnot.The granting of a poulns donot presume
oto give authority to violate or cancel the provisions of am/othal.tater o1 local law retulatine••.mistruction or the sx;
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pMermence of construction,SEE REVERSE SIDE FOR REQUIRED INSPECTION Plumbing ..;p
DATE OF APPLICATION_ 7--47- _(,_SIGNATURE Of PPM 1(,ANT „ 4'4 _ Mel,
IAL APPROVALS SPECIAL CONDITIONS: 'i
AME GATE G'rv� Vi '.(/ Ren Check �.
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