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<br />~OMI>1ElRCn AI,
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<br />llliJSCRIP'rlON OF WH(}( ~E.~ ~~__~~_ ',C'\~o...~~~___
<br />BUn,DUm SIZE SQUARE 11'OO'1'AGE _ L/9. L'JD
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<br />A'fTACH (:;3) l?LO'l' I?LAllS & (2) SElTS OF BUILDING l?I.ANS & (1) BElir l:lIlHiljtfiY Ii'OlH48.
<br />A'l"I'ACII (3) SE'l'S OF BUILDING J:lLANS &: (1) SIllT ENljllHl~ It'ORh18,
<br />l?ROl?ERT1f SURVEY REQUIRElD FOR ALL HEW CONSTRUCTIOH.
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<br />CO!'iI I?AH '1______,.____._...____.___..... ______~,_
<br />S'1'A'I'jjJ CftlR'l' OR REln ST # _..__.,.__'____~.~.~___
<br />CITY I?ROCESSIlW L..______
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<br />CITY J?ROCESSIW3 # ,-.--,.- --.--~--..-'----..--......-..----
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<br />CITY PROCESSING #
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<br />M1ilCUA1UCAI,
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<br />COlvJJ?ANY _____________...._______.._._,_____.____.
<br />STATE CER'f OR REGIS'I' #
<br />SIGNATURE CITY PROCESSING #
<br />
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<br />OT.~R ~-. · .. · · .~.. · .. · · · · · · .. · .. · · 'r:,:,:::,:: .. ;;;::;:.. i:; · ..-------
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<br />~ S']'A'l'EJ CHlRT OR Rlill:lIST # ---.-.----...-.-.....-.--
<br />SWHA'l'URE ,_ el'rY PROCESSING # --_.~ ------..,--'-.-.....,.~..-.--
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