1982, 02-18 Permit: 80-3350 Inspect _ y �
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR TYPE OF WORK
NSEW FINAL INSPECTION:
SET BACKS
DATE REMARKS:
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11 Pl,,,AN I ,OMIT 111131 III 4 ACY - s.. IA., 7O MAKE 3 COPIES L
LEGAL DESCRIPTION—SEE ATTACHED ,,c
1.6o y"Esso sU Noso PAncc��umBERls ,.
L04 I BLOCS B N
2. 1 /G I'ENR'V Pnwz✓ N00/TAwOWNER ,p n.
3, Jaer .54,r0., 9zeEo..+.e Baum
/ .s;hyy
ADDRESS ZIP
6. Aleio torr Nub 44037 tn'iv al a•c�Is.io s in Fest I en IMP
Classification Oa-10-5
CONTRACTOR Size o arc h d 07 9
R J�Fcr/ia 6NYKe oadfS A4h,Q)Yf oaITcT/ sTY-Az:e ZIP Tvl»conac I Occuoancr s er.e
ADDRESS Ovea DNP F10 Rep,
DESIGNER
�_ /ST �NEfA y,. Ion 5011011 Area In Sq.Ft.
OFiIONER PHONE �pm�
6' ADDRESS ZIP Main Floor I Upper Floors Gomm Araa I Storer.
CHANGE OF USE FROM ITO Area of Dacia I Finial.Basement I Un11n.EaOett.nt
a No.Mt s I No.Scoriae No.Roams ro.of...Ina.
TVP[ 0 NEW 0 ALT. 0 AD'N. 0 RPL 0 PAVE. OTHER Rada. e.c d. rot RK'd,
)' OF 0 ELI). 0 PLME. 0 DECO. 0 M.H. 0 POOL CERTIPICAT[
wDRNof EXEMPTION
°IMAM.WORN seam.DIEL. ILaeatlan(Are. fEESCOLLECTEO
a f RO a.,qTOE wa coos
dolt wuaea s ELECTRIC WATER I SEWER own..mry
eooa 9 IOTll chit I I1, Pueur:0PrOOle Di Elrwl.
I hereby certify that I have read and examined this application and heve read the"NOTICE''provisions included
an reverse side,and know the fame to be true and correct,All provisions of laws and ordinances
governing t is Sul.,..
type of work will be complied with whether specified herein or not,The granting n e penultc n
presu
to siva authority 1,,violarn rli n,ii reel the 10001110ms nt any othei Clara or local law I 0011,11111Q rnnstrUCtinn or the
pertoinionl_r of.,i n. i
iNiii..„,SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
_ i OF API'!CANT._ -
HATE OF APPLII'.n HON __-. _. _ �;il;r�n?iln -.. Mon'
SPECIAL APPROVALS SPECIAL CONDITIONS: Nan Check
NAME DATE
co..Resin RaR4ce- Ws!SNEE7RDCC % L,,,,,,5 Roo..?
SEPA
Piannm. RCA/cF "-wee" Fix,. ons .CSee Pcwcy-
Mobile Hems
e.,....mail 2q,N7 7 dd? -Oa750 //////g.
cn Enan,n., � I ,y�1 OIn«ISwcHrlt- '`-
ulm // E TOTAL $JX2^�O ,'
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