38 ENGLISH - BUILDING PERMIT APP WON
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
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BYlldln P1171=Application For. (canna d Building -Ag y e-l-1 j H S
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'(Circle wbichem applies) R0000f..�Rcmf. Install Siding,Construct Dock,Sbod, pool "
�}�!}� �lePl+a.Foundation Only.Wn*ing
PLEASE ELL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
To the b 1pact otBui)digg:; '
The uodwaigned hereby applies for a permit to build according to the fioUowins oped8atioos
Ownerd Nanc (rldvlea Contractor.
Street�j� �y G�I C�. City street �y
State..r4G Phone 0 4 W5-a l a state Phone( )
City of Sam LialL,
street city State L q Hw M
Statc Phone ( ) Homeownen Exempt Foran___)w no
Sttttctitre (please aide) Single Family. mwu Family If_2�odw
Esd =MW Cat of job 3-
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Drawinp Subadued:�n so Mail Perak to:
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Si®naaM d 4Okag:9 S.GNED UNDE E PENALTY OF PERJURY
CON55TRUCTION TO B � OMPLETED WITHIN SIX MONTHS OF PERMIT ISSUED DATE
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