SS9701-CS 920219 Fa t 992
INSPECllON
Job Address:
Descrfptinn of Wcxt to be Done Class of Wcxl(:
[] New
PERMIT APPUCATION
I-I Addition
Date:
Phase or 8ectk)n Number:.
Phone d~
Phone d~
[] Altmation n Repair
Area of Building in Square Feet
Fimt Floor
Second Floor
Value of Work
NOTICE
This permit b·oomos null end void If work or construction authorized Is not
co·echOed within 160 days, or construction on work lo Isuspondod or
for · period of ts0 days et any time ·~r work Is commenced.
I hereby certify that I have read end examined thio application and know the sam
to bo true and correct. All provisions of laws and ordln&nnss governing this typo of
work will be complied with whether specified heroin or riel Tho granting of · permit
does not presume to give authority to violate or cancel tho provisions of any other
fader·l, st·to or local law regulating construction or tho performance of
81gnature of Contr·otor or AuthOrized Ag·hr
I .
iI
Tl~dO3 :lC) A.LIO