1981, 03-29 Permit: 81A-2317 Inspect INSPECTICN RECORD
ADDRESS
DATE REMARKS
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APPLICANT: COMPLETE NUMBERED SPACES-PRESS HARD TO MAKE 3 COPIES
.nsADD[`Ru/ysO}/+yeay�,1Q LEGAL DESCRIPTION-SEEATTACHED 02• •2C6p r
r Ida la•rRO1VI31UN 4 OS ' " RCE MBER/S •2060,0 # +
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ADDRESS ZIP Adoet Sal Back.M PM
IN,SDID I1 MO VII 49264 Nth IERath 40' R 12' bsNu1 2 o 9 BS
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of EXEMPTION I
DESCRISE WORN loom.owe. ILeatlen(Areal •
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yNLVAT URGE OA>1 ILtCTRIC WATER SIw5R Iawn.rmle USE CODE • 1/
L* 2..SL uTt tES SEP1flL Public OPT..0 Errol. E x
I hereby certify that I have read end n<anilned this application and have reed the"NO I Il't."provisions included
on reverse side,and know the sena to 0,true end correct.All provisions ul laws end onlinn,,eis guverning this SO l O 4.9e,C„op
type of work will ho complied with whether Ipecllled herein or not.1 he granting ill i M.o.,does riot nteaume
to give authority to violate or cancel the provisions of any other slate of local law rnonl a,,,i,:,,nstruchon or the
performance of constru lien.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Nrmbine
DATE OF APPLICATION
3/5;/44/_ Sn NAI URE OF APPLICANT/647.-77,74 Rich.
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE SEF. A1-T14c11/13 -MN,: Le&LAIC, Pan Cheek
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Mobile Mom.
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TOTAL $2.0G.00