1986, 05-19 Permit App: 00011154 ResidenceDEPARTMENTAL REVIEW
Approved Curd" Hold
Approval
Environmental Health Application 0 .3
W. 1101 College
Room 200
Planning/Zoning
❑ N. 721 Jefferson
Engineers
N. 811 Jefferson
utilities
❑ N. 811 Jefferson
Plan Revlew/Fire Prwention
❑ N. 811 Jefferson
El Other(IIEPA/Critical Material/ate.)
Fat Trask/ al lnspectlun Information
Prolact Repreeentative Phone
Address
I certify that I have examined this application and state that the Information contained in It and submitted
by me or my agent to compile said a/pppplliiccatitiiion Iss trruuue and correct.
Signa$ QIriC--�.ra.Q Date
_ractor: 0
aimalaya Homes, Inc.
Address:
11910 E. 8th Avenue
Legal:
Lot 1, Blk 1, Grafos Addition
Scale:
1" 20'
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