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� � .:. - r:: .� . .. , ._ W�RKERS CtSA�FEfVSA1YC7'��L�l°�`��``7",�`KC" ` ,^°�.�^�':.,�a« p d ��� �^:�w',r �;�� � � � � , , w � � ,�3':�m�^�z�"°`"�,�r� .'=�.� he eby�affirm that f ha e a cert f caie of co,psent,ro self �yA��q �y nwre or d�CBrt ficale of Workers',Compensation InsuranCe; CE,817��REV�'l�%9iS��� '"�" �' - '-� �- �� ��' ,, ord ceri`ed�copy"tliereo4,( c 3800,Lab.C) � ,/� - _ ,„.-,,„,._�,. ..� �u.�,,,f�.,_,�„, �„.�,,,..�, ,.�,,,.�v,,,,�, ..,,,,,, k �J �'7 �(����� !4'��'��fi3p1JV COl71�Ti�Z5F L�$ANC"rE�`S� BUILDING AND�SA�ETV _ �� ,`Pol cy No.�[:,�_y7./Compa�rcy�(` �/ �/,� , j,�/���x „p . Cerrified copy is herebyfurnished � . . . - � -� ��� �/� . .�"'U�� �, ! � ..` .... � ..... �- : . .. . . . �� FORAPPOCANTTOFILCM`(CRINidR7Yi� ..:`."" "",�`"."` eUILDWG .' ... . "- Certified mpy�is filed wiih the�capnty building inspec- ��� � = AODRESS. �� � � e � tion�depqriment. '� � NUMBER i1XTURE OR ITEM @ FEE ' �� ` �'�"' �' ,,.a,�,;.z. ' �. . - Dpte�7�Applicani.�.^ �,�' .� WAiER�Ct6S�ET ,,.. .. �: . . . � LOCALI7Y� . Fy� . rr , , ��� - NEARESY - " ' .; �ER�tFI�COMO'KE`K[;V�P�i�Y"N"�F��JI'�`/�k`�"' � ," � �, :eniH�rue �� ��� yyyy ceasssr.� � � . ,, SATIbN`I`NSUR�"""�`", ...`�.'.'.,. �. � . (ThifIl "� ..:,- .,,_ . .,Zr , .� .� SHOWER � ._ OWNER � �-.. - . s aecfion�nee�nat be comptated if the work�involved by _., .,, . , , e permif is-for ane hundred tloHars(;100)or_Isss.)� � � �A�nTORv �. � - �"�A�� .� .:� . . i�-.• . . ,� •:... . . . Ti'v�L ADDRESS.- . � '. ,1-�ce t{�y tfiot�in the performance of ihe work for which this � � ...,� u ��� .. � �:'permif is Sssued,I shpll not emp�oy-poy person�n ony mpnner� SiNK '- �� � � �CITY" �. T .� sd b5 io 6ecome sub�ect to the Worke s Gompensation Laws -�� � ,'' .., �:, -�, r: DISHWASHER . CONTRACTOR , C' �� .. D'ate ��� App�wnt � CLOTHES WASHER` �� ' " `�- � ^�'T � p /� � ' ...,,-,.. ....;:�=: . , � AD�RESS�- � : � . . . . . -. ... . . . .�. �., :.�. � �-a a ��;Jr(}cS5� . i, � - Gry- Tel.No. I os ovarter of�,ihe property,�will do the�work pnd ihe � ' � '�� �,,,� ��(�C� '�.j.�.8'� � sfructute� s not intended o�offered for sale(Seciron . � .. � � � - - - .; 7044 Busmess anc�Profession�CodeJ � � � � � � ; , .. ; . .,. �.. .,. ,. , . �.N.�...F.�.��..�.�...,�....x,H�.n a,.,�.:..�a. ,.;. ��;a e-�;'z:� ...m.�.,... w,.......,.,� ,��µ,.,.,�.,. ..�...-.��---a.,,.,v.,.._..�.��. a„ �,�..,.....�._ .�....<�.,.�� (5 cp3097ffCm thCot there�'I�"L�`'P7`�`(R�""'���y` .. . ,.._., _ . -._ �_. . , . � CONS7FFG�i tb �s a construclio lendmg'agency for � � " . �� � "� ' . � � " fhe erfo monce of the wo k for which fhis pedmit is issued � - - . � � � � � � � � � � Lende s Namey� �� � �:� '`° Y�.... .'3 , ..w�.w.w. - , .wa.-w�.,..w.. . , .., n n..: : .�;�+ Lz�de s Address � ,:. . � .� . �,w,.,, . , . - ,,...»,�,�..�.�.�.a.��..� .� �.,�«..,.�,..�..»a.�.,...�.�.�..._,....��>� .�.,.,..ww....�, ..�:.�,.,�.,.�> „.»�...�...,.,,....,..,..w......x.., ,...�......,.....,.., I ce hfy ihot I 6ave read ih s applico+on and sipie�hat the . . � abo e nformat on s correct I agree to-�comply with o�l County � ordinanGes ond State Ipws reguiahng PI� bmg;qnd hereby� - au?h �'e repr seniafives.of.this Coonty�o,enter.upo:n the��� � -� ' � - � � � aboye enti pe[t for in p fian porposes. ... : . �. : �� � . . � . � ..�._....,..._, ........r.,,. _ �.,,�,�.,.. ...M._..:,.._.... =' _.», !y� � SEE REVER5Exf51C E�PLi1N7S727R`Yi7'�`ii11f'�E"".."" �." , ., . _. '. ignature of Perm�tee ' pa�e� � � � � � � ��. - ' L ` . . " -. . . . . ��4 � �<i: �yy , . . 'f .�. d .v�. .. .,.—�.•._, ,�..a,..e � ,,. �,.,t.. .,. � . .. 'INSPEG70R S hOTES ' ;� ..; .., r �Nf�.'E Fr D R� E �R� N ��_, -. 3�7� TI ,aokac nes =^,.;. 'i}3Sa� Rs`si��'Avt�R� �._ �.. _. s,��u , , � a�sb��� ��+*�+.�: ...,�«..��...� �.. RY � � �UN�ER SLAB WORK'� '`� ��9/'O'�— . , - I he E aff rm th I I am exe p'trom�"t Ce cci _ _ . - �-{-v-t--� � .- . � „....... �:. . n P l tor tFe +o I .v��g eason (Sc t o 7031 5 ROUGH ALUMB hG � , . � ` � � IIi siness and�rofesvon Code Any ufy o �aunty �� ch �__ ,�� . . . .. . . . .. � �GAS F PING� - �_ `� - �.-- _.,.._...._,..,..,„.,... ..�,w..,.,..�,.w,,w�.w��„.„�,,.,, „t,„�y�-�,...�.,,.,, rsquires o permif t construct alt �.improve d�mtl!ish, ..GAS VENr �. .. . .,. w� .. . �_. . .. . . . ,. � ,� ., iss�once,.�nlso re- oY mpmr any sfructure, prror to ��s HOT WATER HENiCR " �� ' � - �-� �- -�� �"f'�"^"'ai*"� '"�-"^"'_'"�q�uirss�fhe applicanY forsuch permit te�file o gned str,fa� .. .; _ ,� . .�. �.� w��. -��- � � .,„ ,,,_, ''-` � �-� -_' ` rr�eqt,,thaF he is licensedpursuani to fhe prov7sions of fhs � • �.' , ' . .. . . ,,..: n i arv�':....v.. S�A�snw.+iY�3.'^k"w�»+'x'*+Rvf�qrq+;Y«Y�.d�'.tt�ua�¢'^'+f:hd,�vl COf1PfOG�OtS LIC viiill . GAS'E$7'. ,:�... � ... d' Section 7000'oen e 4aw(Chapter 9(co Qn ny LUMB�NGf�%FURES „ �� �',. . +�g, � - f Oiv�s'ron.3 oi i6e Business,ar,d Profes- -� ..� ...,,::a: � �.. . ._... -- _. . . �� U7,L�TY��CO.NOiIFI£t7 � �� ��"��� "'"�•'+�°' --"^'�'�^�„fi•' "'=_"" "sions Code�or that he 1s azempf fherefrom ond�ih�bos�s . _ � ...�. . .,:.. . . . ' . ,, ._..: . . . .. - .� . �`, . -� g ❑t)on: Any violaton of SecNon �� C=n{ar o.� _3 nn.L ��. ..�.�� �"����� ��.. canf�to"a�c�v I pennityt(or.a permit subjects/he appli- FlNAL ' . " n . �� �� � � of nof more than 1roe hundrec"„_,_.... a. , . ..�.,w.. ,,.�....., ,.......��..,.�� t .,.,,......a.�_ , ;,,_.- - _-:..�,�s:.x.�a-�,.a+-�,-:.-�.�_�z- _�;�w._�_: dollars(5500). <. ',.. . _ ..... . ._ .,,._. ..,... : , �.� :� 4 � � �� .h ��^��.:� � . . �. �,. _.�., .��..w fhe s ucture s otrmternd drop offe,e'�.I do ihe work,anu _ ... ....;�... .�. . INJJST,RIAi. " „�. �° ,,,._ � _,..w .._ ,._,„„ . dforsale:. .='�� v�,�o.STF'qpF2eba� ' ;) .' '.';,; - - `.� " *�.� � ` > ' $ec 7094 Bosiness and Prof s ons Code Tbe Co = ,-; _. , .;.a. �. ;. � .:.; . . �.,,. i.�:, ,� ..u. h-�F- ..w,��,.� .... . � �.� � _ . . . � es i ,-,,.-.,.,. ��.,�, �- , ... ,�.,_ ,���-� . . ' �+�=+ �fors-17cense Law does nat'apply to an owner af property . . ,. .., ..,_�.� ... . .. . _ � . . . . . . . :;�.: :.. .;.. ', , ,,. .. . . , , ;.,' � � ; . .. �� '' ''who bvi(ds oc improves���fhereon,�ond who docs such - �- ;� `;�. �� ,..,,.,..;,.,,..,.�.es�-a.�u„a iprck�{.�-a��t,..r_-��.�V..aa�s;�..work hfmse(f provided fh,otsuch..improvements�are�nof _ ,, . , _, .. .a,. ..-_, iu � . . . . , 1.. �: _. .. . . ,<. .. - .,�:,.. , . . ' � . � �_ '" �.� '��" , �" '" ,�-., � �`� infended or offered for sofe.)f,howevar fhe bu Iding ar ;��:: �� �� . .. :_ � . ... �. . ..�. -..... -.,--.;�.H:-�.�,„.,.+<��+;�=,�.�,� improvemenf,is�sold wifh'n.�one ynar�of compleiibn,tF,e .,,�,.,. �,.._ . . . � ��-�--� � � ' '��' ' '�� -,� � owner-builderwi0havetheburdan_ofprovingthaf.heairl ' � . :,. .�� . ;�—._ _... . ..,-:,.- __...._.._,.„:,m „Y.:,,E.,,,...��..�.�...Y„ .��, _, ,.,,.,.�z,,,.:....., , nof�bvild or iinprove.forJhe purpose a#sale.j -.; ' � ',� . , - -_ .; . ' -->.. _ . .. .� . . ... . _ .::.-� „ , , a,v..d...,w... . � . ' . , � . „... _...,,,......��� sr�, .. - .� .,........,,.:; . „�,.:,�.. ; am exemp.un er e5`c. � .. . . . 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