1981, 02-18 Permit: 80-3123 Inspect INSPECTION RECORD
OWNER LOCATION
CONTRACTOR TYPE OF WORK
NSEN FINAL INSPECTION:
SET BACKS
DATE REMARKS:
2--1 5i ded
ir
APPLICANT COMPLETE NUMBERED SPACES-PRESS HARD TO MAKE 3 COPIES
•ADDRESS
h h���//yy,17 ` LEGAL DESCRIPTION—SEE ATTACHED O2• 600 F
2 I' 6LOC ISU PARCEL NUMBER'S..7}3(3,�t�a
P aN^-T
a,oleq/i�6r. i..L' ...coop
i AOT 7 Bid!2 3 1?2 P
9.2G-961� 00-(4-BO
�{ ZIP
p CNERR.y SVA. VERA
�o�/:fi Sow°Gyri- a04..-7yjrLd.a/d�1_. SHon 37 e.tn g) ,`•'seem bye' ' ' iwnt/A, 4479
od Sim of Parcel •o�`TOme.Hon
4. .a. . se z
oaaut.wwt nnxS pn !` zip Type come. I Se
❑Ter ❑no ICI q.a�a.
DE
PHONE vau•tmn
Or • P
w5t.6. ADDREn ZIP Floor, !Upper Piper. Perm Or"LI Ste
•-
T 7GICNANO[OF us.FROM Ino Area of 6. I PInSM1M • manr n/ln.[arm.
6.
nl
No.BabeNo.Stade. I No.neem. �no.of OW.ulnn
TVP[ KNEW 0 ALT. 0 AWN. 0 RPL. 0 MVE.
7. OP ISI /
WORK 0•LD. 0 PLIAS. 0 MECH. 0 .. CI POOL O OTHER CERTIFICATE Reed. I PIA Net Reed.
CRI•[WORN Of EXEMPTION I X
& .0 Dem.Dist. Location(Neu
T /.I�Atlir4p"� I fiid COLLECTED
vgwnnD SOURCE oAs TEL[ornm I WATER I SEINER pWmrn wwa I uae cpoE
B, UTILITIES w uc❑ e N &rel. J
I hereby certify that I have read revere, examined this application and have read the"NOTICE"provisions included
on side,and know the sameme n
to be true end correct.All provisions of laws and ordinances governing this O
type ofwork will be complied with whether specified herein or not.The granting of a permit does not presume ''''"'M if
—
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.SEE ADVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
nAIE OF APPLICATION T—4"if e SIGNATURE OF APP I ILANT ,J,Y--------
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME GATE
Plan
if�7rs' 74-lber 4ao,4yZ/..t Check/ SEPA
X.—".-";
,/.,�� - 7 / Mobile Hoole
Co•Eneln..r ,j.i�.
/� e Other IEP.aInt 00 J
Weir,wrwiom TOTAL S utiter
Ste" � / 10
WHEN MACHINE VALIDATED IN THIS SPACE.