150 MARLBOROUGH RD - BUILDING INSPECTION t>�g: I
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PLANS MUST BE FILED AND APPROVED BY TSE
I NSPWMR PRIOR TO A PERMIT BEING GRANTED
Building Permit Ap or. laeatba of Building
(Circle whidu3ver applies) Roo Reroof, U S' ' Costsma Do*Shad,pad
lion. Alteration,Rgwid A)l8ce.Fottgdatioo Only. Wrecking
Otber: !
PLEASE FULL OUT LEGIBLY& COMPLETELY TO AVOID Df LAYS IN PROCESSING
To the hupeesor of
Tha uodentiScced here�byhrseby applies for It permit to build aooadiog W the LoVowioE apod8glioos:
Owned Naase " (� 1 Contractor. Pvi a� L Gnr c 11'e�c �F,
—L ( �crl 4 ra��hgCiq Sel_QNn1 Street a�d�, o City .) 5 J� JS
state /I ct Phone Ogg)
State./ c-L Phooe(N)
AreWleet: City of Satan Lill ,
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City Stan UCO ��
Sate Phone ( ) Bomeowaen Etuapt Foraa�as ao
Sums urrc(plem drde) Single Family. Mubi Family___O
Estis aced Cost of job 1;.220 0
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WIN bttildiag IaN!, no
Mbatat�n ./_ No
Daeeptiaa of work` be ((��
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: �_ no Mail Permit to:
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APP�,S GNE UNDER THE PENALTY OF PERJURY
C N RUCTION TO,
B OMPLETED WITHIN SIX MONT$S OF PERMIT LSSUED DATE
Departrtregt use ady: Penati�Y Zo*g
Permit fee s --T_
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