1982, 02-10 Permit: 79-8766 Inspect 7
INSPECTION RECORD
OWNER
LOCATION
CONTRACTOR TYPE OF WORK
N S E W FINAL INSPECTION:
-SET BACKS
DATE REMARKS:
-2- .cie‹ A
•
_ .. PERMITNUMBER
PCA.NUMBER _g 766
DATE // " `
APPLI 02• 1+1000
gBADDRESS 14.� LEGAL DESCRIPTION-SEE ATTACHED .1 00'0 •
1. Lp T BIOpC �IVISION L�� PARCEL NUMBERS 2O e44�"A,50 8765f
2.5§l0 3-3 ONIYq'-A=1P �y Tf
s. °C!"i toIGI 9Po-3719 R.gwr.as.l 12-06-79 606 .
AD�REiO(o,. l+rt+ I Z'G No.l Parcel I e,l 5 ItO II
cONTR eHoNE Elie EQ.Claw]..
��n1 h'ox,ISOeeaPaner ki+Mg41-1 e,
4. A ZIP r Hreul
Oras ON.a❑Rep,.
6' ADORE55 PHONE ZIP OWL
Valuation
OWLLArea IDa.e�l Area BOwatie Area. In Sq. • —
ITD Spilt Entry I Sant Leel I Rancher
CHANGE OF USE FROM ����
Room
e. TYPE S/NEW ❑ALT. Q' 0'N, O RPL. 0 MVE. OTHER CERTIFICATE R No.earn, N.Ploara1 aA'C.P Room.Reed.
ReeNot Re.'a.
7, OF 14LO 0 PLMB. 0 Moon. 0 M.H. 0 POOL
WpgR of EXEMPTION
EWORR ( -+) FEES COLLECTED
a p�up�ioN� f�cl�f: `loll�IYJ- r/ �C/i 1TI Ip ySEWER
�
9. �Oo I OI2 I•• -S I V's Rlc I W"a 1 I�-r I Ic, Single $ed _
I hereby cot Lily that I have read and a am ned this application and have read the"NOf'CE Slices governing this I�"
side,and know the same to bel nue and correct.All m',vlsions of laws a Id 4RuiMrng
on reverse
work will be complied with whetherspecifiedherein oI r.The granting cd.,,,..lied clues not pi esume
op give authority to violate or
cancel the provisions of any other stale or local law Iruilalnru conslruatlon Or tno Pl,.,n.ing
Performance of construction. �//,,/{,�/ �_ ..
DAT E49IGT7 9 SIONAT1J 11 _,. mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: E.aI _ _ 19, Plan Cheek
Pr REGIS.D. 18811aa�c,,TT��,,�ti,,1IA�UII I,, .RIa%O'I
Env.nxltn / SEPA -
E:.r,t
Mobile`i''..... r other lSPecilvl
WORM TOTAL S
G��V
ZOn
leer WHEN MACHINE VALIDATED IN THIS SPACE.
SEP C C I. T BECOMES APLHMIT.
BEPAah.ghlet „e.ee=�YnF IAL H112"061-:79 8766= •1o.o,og'