9 BERRYWOOD LN - BPA-2004-921 DECK AROUND POOL ill
fL�tM6iM!!8t'eE , OVED BY.T44E x,
JdSPECIL�l3 QR JgPkRm*A=lNQ GRANTED !`^
CITY OF SkEM
No.
0
Is PmpotY LOOWd In Location of
MN Nidado Diddcl? YM_No bdldias
CawMtlgn Ma? Yo_No —'
BUILDING PERMIT APPUCA71ON FOR:
Permit to
(Circle whichever apply) Root, Reroof, Install Sidin Construct Deck, hed, Pool,
RspaidReplacs. Other.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROOWWft
TO THE INSPECTOR OF BUILDINGS:
The undersWred hereby applies for a permit to build according to the folbwkp
specifications:
Owner's Name 2a A ?"6(
Address & Phone
Archfiect's Name
Address & Phone ( I
Mechanics Name
Address & P
Whd Is w papm it eurano? v o %c +h
Md"Or M~ i v p G N a do g,for how,many kmaa? ! .
WM OWkbV W tom to law? 1--5 EIlmaad cod. ' COW Lkmm• N p` am@ •
ww+.
Lie. t X71
" a Sloafure of Appllcant
SPNqD UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
A 0 74417
INSPECTOR OF BUILDINGS