/ l' U 1 , r iJ,n,l.-rAe,, 1
<br /> Permit No ©C CFt,UtJU U'J.D2 Wg27h
<br /> jJr;`�o'� ` ��r�� ���0C�� ��
<br /> • Mppt.r t 10 comp/efo numbered spaces only:
<br /> 1 SITEAUDRESS
<br /> „ :741—..,:-
<br /> 74 � :-:Q2 I — -
<br /> I a�3 {� 1 v ew M o ,(�.S U�e cLJ m Ssrla..
<br /> ls
<br /> 1OWNER MAII.AUDRES$ 1 ZIP PHONE
<br /> 2 —Ttzodo r•e- Q? (Tarin s —,=1.�.3 G t...1: ((vLew Rd., Mocunis Ui.ew,M is71,;. 7g-s7/y7_
<br /> r CONTRACT R MAILAOORE.SS ZIP PHONE Q
<br /> J QC(C40p 1�a-Ji o+ MAJ ,.1-vie. , P!&u EN3?Y, g(�i.ikit (4AJswg9 7N-a7s-•
<br /> T''
<br /> .4.RCHt7ECTIOk::SIGNE •'ENGINEER MAIL AODAESS ZIP PHONE (�
<br /> USE OF SUILCINCI
<br /> 4
<br /> DESCRIBE wOAK
<br /> Lte‘errk.lk ci_5(A6.,t+ av t v gwcui .
<br /> .I
<br /> t .
<br /> VAwAT,JN Cr'WORK
<br /> NOTICE -r,.x oc .ncr umGxx �O'p Zonf
<br /> iit af!?MI BECOMES NULL ANO VOIQ IF h'ORK OH CONSTRt1C71CN �d No A F4•Scrori..s
<br /> •I AL TNORIZEG t5 NOT COMMENCED WITHIN 110 CATS.OA IF C�ISTAt,CT]CN flop
<br /> SWAN (R,pyafd , Yes .: Vet I
<br /> CA O'OkA IS SUSPENOEQ OF ABANDONED FCR A PERIOD OF 120 DAYS AT R°WI SA.A. 1
<br /> AtvrT,r.1tAFTER WORK IS COMMENCED. OFT'STREETPeP,cNGVACCS t
<br /> : HERESY CERTIFY THAT I HAVE READ AND EXAMINED TNI$ 0..
<br /> 1 AFPLICATIC?J AND KNOW THE SAME TO SE TRUE AND CORRECT.ALL .o t„,,,, oar.ma tLawwae
<br /> PF::VIS:ONS OF ,AWS AND ORDINANCES GOVERNING THIS TYPE OF WORK LfVf, [TRW? OLOCK LCT NC. ,
<br /> ',SIAL aE COMr.1E0 WITH WHETHER SPECIFIED MQREIN OR NOT. THE OIiCAP„o,,,
<br /> r+ANTINO OF A PERMIT DOES NOT PRESUME TO'iIVE AUTHORITY TO I
<br /> .iQl.'rR OF CANCEL THE PRCLISIONS OF ANY OTHER STATE OR LOCAL LAW sp.cul,MD. Rpy14 R•ew„mC Ro4 Row.au •
<br /> IiE3L,LATING CONSTRUCTION OF THE PERFORMANCE OF CO STRUCTION _
<br /> ROCO'LAM
<br /> S-14-N wTU E OF CONTRACTOR CR AUTHORIZED AGENT (DATE) W471..m40
<br /> _ cFAietAce REPORT
<br /> Siu:4ATURE CIF OWNER(IF`WNER SUILC€-R! (DATE) OTHER(Samba
<br /> J
<br /> IMPORTANT TO APPLICANT—PLEASE READ EASEMENTS C ries O testers&aa••••WM et ea*awl.
<br /> ':P£CIAL rt+f?IT10AS 19 pre PyrI '14-Z : (Jtec. Uctn,5_.
<br /> SEPA!~ATE PERMITS REQUIRED FOR: j .. , , •. : . CI ;•..•���, - 1.(- _C
<br /> PL..MOING # — I
<br /> , N y' • -4. „-, , ^. v ll L.Y\ : 1� •,—(1) •
<br /> !-8E.�,TING, VENTILATING ,, •j ---.) 1 / --
<br /> CR AA CONDITIONING N
<br /> ( — ''MtKs110w NGC VTm fr I ►U,ww Cmi(rfO eV J *YMI:.CO Loo r'ibu.CE Y.
<br /> ELL-L fRICAL+1
<br /> SLACKTCPPING M i -1
<br /> SEWER k &WATER # cCNTNAt rORcL,CtiNS
<br /> sTATE j 40TREOUTAE0 O re j AEr,C,,.G
<br /> THIS IS AN APPL:CATIoN ONLY �q
<br /> zeRWFc
<br /> Te 51 4-5
<br /> THE PET-WIT WI_L SE ISSUED AFTER °UN Cw Ertc FE6 I
<br /> 01RE'v,EWAE Cr THE APPt_ICATIO?!. supC.AACF 1r
<br /> I iwM OtraL,E }t �_
<br /> l LCEN11t CMeC 4 Si
<br /> TOTAL FEE s
<br /> )0/cif?$ -Cv;1 ( CGo-e yet. ,-) S Ci_
<br />
|