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Permit bCation Fax-m-78DW21 <br /> 81&78G4)= City of e <br /> Date mod. Plione:Cpdsotior <br /> C <br /> e�.� OrrtwPltoneN4urt6er'i <br /> V9 <br /> ��Owneftl <br /> Otwnef:Addre rs OraeerT+Itone Ntrmi> <br /> Fee ,Rid,omer,Ytne:. .. OwrmPUonaiiantier.. <br /> Fee simple lilleholder Addn <br /> 1 <br /> WADOPI <br /> Ze phi. <br /> PARCEL . _... ...'- ..., <br /> �/ DL D DD oD G <br /> ro <br /> WORKPROPOoo. <br /> AIR: 9U /ALT =p: slc , p.:_ _.; .°-, gino►�sH- <br /> :. :- INSTN7.!: ..' ':':;REPAIR <br /> PROP06EDUSE :OTHER. <br /> TYPE OF;COIIBTRUCTION- Bf OCK:'=;_, FRAME <br /> DESCRIPCYOItOF <br /> WORK::;;-.: _ GSa. <br /> BUILDING SOS SQ FOOTAGE_. . HEIGHT. <br /> BL�ILOING S ";,;- .; VlILUATIONOF:TTALOONSTRtUC71ON <br /> 0. <br /> =ELECTRICAL S. .. AMP.SERVlM Q RROC�IiESBENERGY. Q W.R.E.C. . <br /> =PLUMBING S, <br /> MECHANICAL S.�r/ d VALUATION OF MECHANICAL INSTALLATION <br /> =GAS Q ROOFING' Q SPECIALTY= OTHER <br /> FINISHED i100R ELEVATIONS FLOOD ZONE AREA =YES NO .: . <br /> BWLDER COMPANY <br /> SIiiNAtt1RE W.WrEm. . -Y/N.. nm cumin .-Y/N <br /> Address License# <br /> ELEInac Nl CAMPANY <br /> SIGNATURE Y/N �yut+nN1:.- YIN. <br /> Address, Licerm# <br /> PLUMBER. COMPANY <br /> SIGNATURE REGMERED -Y/N RiGfMBr.. YIN <br /> Address ##--- - <br /> MECH�Cp4 ..` COMPANY <br /> SIGNATURE. ��� <br /> .: REWSTEREDY/N -PEkQ0t �-: Y/N . <br /> LIB#. AGO <br /> OTHER' ': . COMPAN1f <br /> SiGNATURI's YI•N.' TEECL e:, . •Y/N <br /> Address License#" <br /> T,1 LI'F:17:'=1 1F-1'/.1,.1.1'II t:i 1.1:1'u".111w 1�1.11 1 1 1 1:1 1./•1- a l l 1"I:I I I L I1 1.1 1 1:1'1 1"1 <br /> RESWBMAI. AtIpdt(2):Pbt-Pints;t� 0. (1) .Eriarpy.Fe iZ-0aN.Paririi{-tornewoa[�strir n'. <br /> 1�'ntarant�n�tll�:uthrlvnQ daltsaRer�sl�tnHtal date.:Requied4t�e.'ticirhudiar Plans.SloimwgEer Flares w/,Stlt Feno®ud. <br /> ! FaoTti�S t dutiiRicier:t'ade_Wadr Petiir3 for suNt6risicns✓larpe projects <br /> lOIB/ERCrAI. ,.A1ladr(2)"mnpNl�SetSdBta fg'[?fa .pYssCife.SeYelyPapa:-t1)sidatEnergy.Forrm.; RAWPemritfornawcarKtndSon. <br /> Win tali(9Q)MVliuWft%i**: dMe,.Requr taisie.OonsUiMxion:Pfs s.Smrm+r sr i?Ians.x9 Stet Felice k ised... <br /> y;Fai :6!_duieF wgic[ tiiEio►m_iie�r viojects-a oonimersial:telr«iietiis:u+i/stmeei <br /> SRGN PEWT . At scbh. :t*0. <br /> PROPER YSUFiVEYtegl�tldlwlamNEWconsouctiat.: - <br /> Oinrdioit�• - - - - <br /> Owner&Conbadnrsigntiadretappical on notarized. <br /> ttbrr�r•S?AGQ;.ra:NotkyoE 'Nswquirrd. tl1lCi�prades_owS750tn - <br /> Agent"ftim ito�drac .a Poaer of AUDlney troSll o et)wcWdte scrritione wiM nW imd.Net�®rSF«n owrar auUt4tIDrtg s�na <br /> ovii# COUAITEti PQatt18i6 :-; (aopyol ea[drac3 iegrrired) <br /> Nteroolsifshotgles '"_'aewers ,;88rvk�t?pgridwss,:A/C;•'_ FerxastPlof/�arsylFootage) <br /> Direr Coratter itort public readvrays�:neerls Row- . <br />