1981, 05-21 Permit: 81A-2888 Inspect INSPECTION RECORD
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PLAN NUMBER. _... . (,
NUMBER
.. g I A'qr 13/ai/si .a ' ,I'S Ass' 6ToPERMIT
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PARTMENT
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APPLICANT- COMPLETE NUMBERED SPACES–PRESS HARD TO MAKE 3 COPIES
1.-.177 .„
„ 4� `. , PARCEL LEGAL DESCRIPTION–SEE ATTACHED C 7 .9 B 0 0 F -
9 T R//C :U��7l ii"G. 1-1 I 1�5 NVMBERrs'.L4 53I' 34 ori .08006
• ER "''l '–'44 IA Val I K' O�yE n .000 0
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. P?'")-Q'O 5."o,I s.,e0 Isoul'1173 0 I.r 'Watt 10 N P i
C° H E a1 ,s I o PlospooTI — C3-31-811
4- ADORERS - ZIP wlr',w/L`a' ll� z IV'. t4*"• i.44V
D ESIGNER PHONE V.w.�l ��RT""
❑1151 A❑OLA s❑.Fl.
'. ADDRESS
Floor. Oarma
CHANGE OF USE FROM TO ZIP M�a Arita Oeek.O�•rFlnldled S..emen)Aru}Re.p.e.m.nt
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TYPE 0 yEW 0 ALT. �AO'N. 0 RN— 0 SAVE. No.slams I No.Stool.. I7 0.Room. INo.of Dwelt,.
'• w,,,,,, EEJ 0 even. ❑team, 0 M.N. 0 POOL ❑OTHER CERTIFICATE I Owed. P.c'S. 001 R7r'd.
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O CRIBE WORN nuN
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pm Location I V
nn lArbl FEES COLLECTED
6 AS1 OnI
VA TI N PCE GAO ELECTRIC WATER O**71 1 p E CODE
E. tarlui¢s % vmra❑P,m.t. ua Single S
I hereby certify that I have read and examined this application and have read the"NOTil'.l urov,slons included q
on side,end know the same to be tr a and correct.All provisions of laws Old 1111..'res governthis F g.
type OE Work
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p
Work will be complied with whether specified heleln o sot•Ihe granting Il:11101110does not rpresume Bing `
to give authority to violate or Cancel the provisions of any other stale local law 1eg10n1P,11:.onstructioll 01 pin '
performance of construction.SEE/REVERS�E SIDE FOR REQUIRED INSPECTIONS I Plumbing
DATE OF APPLICATION 3- '� v —_SIGNATURE Or APPL.LANC ite XJ�/n�A/ 6l__ Hsieh,
SPECIAL APPROVALS SPECIAL CONDITIONS: I r,
NAM[ Plan Clime 'Vl.
,istriewmodowtr
ev,
SEPA --. c t
OM..,.n.p Mobil.Over.
r.41Rneln..r
Other lSp.clfyl
tAeNN.
TOTAL $'C0.2
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Kens Examiner •
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