Appleway E 17717 Remodel to Store Front
' (THIS IS NOT A PERIVIIT)
` BUlLDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN INK
(Please return this original and your building pfans to the Qepartment of Building and Satety)
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I certify,that,, I have examined this appltcatlon,and state that the Information, contained in it and submltted
by me or my agent to campilesatd appllcatlon 1s true and correct
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