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S�f���D I�C�� �1--+-7 � {� � r.J L_0 �>'�-`'� (�=� �y0 Z S CON7RAC"IOR NAME /p`,, ^ � � "�� PHONE E-MAIL � , � (.��. k� �u,J.�`t�uC��.vK./ '�rJC� ����v�._�(3 .- 2 �.� �'i (c,s�c�S �' ��(.�-��� ��� n���2.�ic.�io�i�1 c�, STREtT ADD� 3S d �l� � l,( �c.,� _ CITti", y��A� �i��I-��A C-1 /_X/ J l/ k�� �" LJ��� j f�/ MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery): coNTncr rrn�rr r Puo�e -��� ' �i�1�� �-Mn�� -- - �� � �� z f CJ c� � <,���� �� � c>_ —s�;�� � v �i, � :��s� .,�-h�w STREET ADDRESS - � • � CITl' STATE,ZIP � � �{�— , �` � Fnx Lµ-G, � �� �-�U� � � � t ,� �� � ��� ,�-�/`� �-/ � ��G���Z: � C���c�( LIST ALL BUILDING PERMITS ISSUED FOR PROJECT: PERMIT SUBD�ITT ISSUE DATE INSPECTOR SCOPE NUMBER DATE DATE FI�VALED i �-&�'�-D�z2., �% �� L ��r3, t� � ��'�t ►� �l ..�-, f—� �,��-C_ 2 3 OCCUPANCY DATA: USE OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD 1 -,f—=� t C_c�- I �� �. 2 3 4 BUILDING DATA: #STOKIES #ST012IES OVli12ALL MAX OCCUPANT PIRI?SPRINI{L�RS FIR�SPRI\ICLERS B�LO��'GI2ADE ABOVE GRr1DE PLOOR A[2�A LOAD 12EQUIRED (]'ES OR\`O) PROVIllED (1�S OR\O) #PAI2KING #ST�\DARD/CO�IPAC"f #ACC�SSIBLE REQtiIR�D PARI�I\G PROVIDED PARKING PRO�'IDED 1VOTE: ATTACH A COPY OF THE SIGNED INSPECTION CARD TO THIS APPLICATION. - OFFIC�USE ONL�'- SPECIAL STIPULATIONS OR CONDITIOI�TS: CHECKLIST: Copy of Job Card Attacl�ed(botll sides)? Ye�niit Signed off in system'? No other permits open ur es�ired in system° Locatioi�of Approved Oftice Set? 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