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DESCRiHE Soft Water FEES COLLECTED
!hereby
LL, TIr.IV OOTCEsI GAS I ELECTRIC I wATER sEwER elle❑Pn..I.01 USE CODE
Lily that I have read and examined this application and have read the"NOTICE"
Single S
o^ and know the s o the true and correct.All provisions of laws and ordinances'sio a included
typeofwork se side.and
he complied w. whether specified herein o governing his
to give a violate or cancel to
provisions of any other sot.The granting tate or local law re a regulating
permit not presume
Bu�I g
performance of construction,SEE REVERSE SIDE FOR REQUIRED INSPECTIONS egulaong n rucho r he Pen 5 S.00
DATE OF APPLICATION SIGNATURE OF APPLICANT e
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SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE Plan Check
SEPA
Mobi
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• °• TOTAL S 5.00
—'n cp<..phi I THEN MACHINE VALIDATED IN THIS SPACE,
HIS BECOMES A PERMIT.