29 BUCHANAN RD - BPA-2004-931 ..t
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JdSPECItIA fQA I*AUWG GRANTED
CITY OF SPLEM
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Permit to: BUILDING PERMIT APPLICATION FOR:
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(Circle whichever apply) Roof Reroof Install Siding, Construct Dade, Shad, Pool,
Repair ce. Other.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROC!liWft
TO THE INSPECTOR OF BUILDINGS:
The undersignsd hereby applies for a permit to build according to the fdW&*rp
specHioatlons:
Owner's Name 1��/ee-7 L,e c,
Address & Phone h -q7 A/ (9J21 •7 <"" y- 8 o 7
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone
What Is to pmpon of b11NdW
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Signature of Applican
SIGNED UNDER TH
OF PERJURY
DESCRIPTION OF WORK TO BE DONE i
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MAIL PERMIT
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APPLICATION FOR
PERMIT TO
LOCATION
DAl
PERMIT GRANTED
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APPAOVfD Q ,
INSPECTOR O BUILD
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