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ISSUANCE �� ' _""_ '..._....-_—'" . ..__'_''"__ . ."__'_ ��lG� p DATE:_ '_._'__— APNI.ICANT: _ ._ .____'_ ___._—_.. , SMIP __ .__ - .. , . ...—.._.. _ � J WARNING:FA1Ll1fiF TU SECURE WOHNERS'f,OMAENSA7104 COVEf7AGE I5 UNLAWFUL,PN�511A1L RC ENERGY P/C .__.,_____�� ������ __ � SU13JF.C'ANEMPIOYERTOCRI!dINALPENALTIESANf]C!VILFWESUPiUONFHUN�REOTHOUSPND ENERGYPERMIT DOLlAHS(S IOO.n W J,IN ADDITION 1 O THC:Cu57 JF GOMP[NSATION,OAMAGES AS Pf70VII1Cp FOR IN � - " __-_ '_" _ _-_ "_.. .. �' SECTION3�oeOFTHELABORCpDC,INTEREST,AN0AITOHNCY'SFEES. RETENTIONFEE: ' � _ '"'_". . ..._ O CONSTRUCTION LEN�ING A('iFNCY PRE-ALT FEE: , _______ __ ,__ � IHCHFBVAFFIflMUYIJEFPENAINOFPEHJUI7YTIfATMEFE�SAWNSiHUCT10NLENDIKGAGC-NCY �- f0f1 THE PERFOqMANC[O�THE WORK�OA WHICH 1HIS PERMIT IS ISSUI:U(SEC.3077.CIV.C]. ----" '-'" --' ---�-----�--�--- � z ""'— W —_ _ _.._....... __.— _____ '_"-- '� LENDER'SN�ME___ -_._ ._.._-_ . ..-..... ... � F- LENUEH'SAUUn[SS � ' TOTAL FEES � ,�� . ��Q � If,EFlTIFYTHATIHAVEH�AUTHISAP�LIC�fIONANIlSIA7[TMATTHEAEOVLINFUfiMAT10NI5G�NHECT, ��� '� IAGREETOCON%.YWITHALICIIVANDCOIINTYORDINANCESANUSTATELAWcJRELATfNCTORUIL�INC � GONSTP,UC7�ON,�NDIILRf:eYAUTHOR,[FqFPr�EE�NTAT!VESOFl1iISC()UNTr�TOENTERi.;PON111E � Z A80VE-MF.NIIOVC;DPROPERTY�OIII PECTIONPiJRPO5E5 I� (_ _ COMMENTS � o ry 1 _A '^ -.-. --__.....---- --'--— _' �Q_ 'l� TI�CG✓7�'�la.�:�' o �� . — ---- - � ------ -- ---- -- — -�------- ------- --- ' �� PERM.ITI EE AA I�TI!� ... --""..-.. ¢ � � /� - '_ � ' ___"' � SIGNAT F FP&HMITTEE 0 E �, -� �j �----��--� � � RECPT.NO.�,� _,__t�.�pq�p gY ��+'��__ VALIDATION �" WHITE—Depahment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLOENROp—File Copy,GREEN—ApplicanYs Copy �� --.W._._.. ..._._rv.�... ^ r ,__ _.��__- ) __ r : i ,- "1 1 I---, _ " ,- __� i � I I ��➢ I 7 - t r 7 i � . � e L � �� t 1 t ' r, i � ! � � � 7'it ) �. 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