1981, 02-06 Permit: 81A-1166 Inspect )
INSPECTION RECORD
ADDRESS
DATE REMARKS
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/ APPLICANT: COMPLETE NUMBERED SPACES-PRESS I IAno TO MAKE 3 COPIES
L'JOS ADDRESS
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CNANOE OF WE PROMR I Pistoled eN
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1 m.DID. Location Weal FEES COLLECTED '
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I hereby certify that I hive reed and examined this application and have read the"NOTICE"9,041011S included f
Oh Marla side.and know the Boma tb be IIUe and cerr0CC.All Iflovnsiens of law and ordinances governingY this Solidln 41-•
type of work will be complied with whether specified nerein or .-I hr granting of a pmm^r does not presume
W glue authority to violate ar cancel the pravillanr at any nllo slate..t local law reesdatlny conslryction or the
imrtormenca of eonetntetlen.SEE REVERSE SIDE FOR REOVIREV INSPECTIONS Plumate
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ri:
DATE OF APPLICATION J —•••-2'..�1-__ SI 501101 or 11.11 ICANT A.-�`^ Y --( Mon.
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SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check �$ r.
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TOTAL 1I.
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