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ce t"law lues sat It*a an poser of proWy+rho boiide of tmpwra Ntwon.UW
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I be dby aMan oatler peatliy of perjwy nn d Aha failkr mj d+acln sant'
C] 1 haft uid w d rowtulo A r7 tilimt or camrs to$01"inwie rar w4~4Compen. _
utiur.a mwi&d fa by Saetlwt 37M of the tabor Calc,ror 04 4etf"ata of Aho
aarE ra whkh this p�R is.astled.
r3 I taws had Will tntinwn%'alters Comyasu40M matt"e,a Mquitad by Soetfos
3700 of the Lab"Cute,fa th&.oerfamtexe of ibe+iwlc ror whkh thls potmk it lasest3
My WwkcY Carnlpuludon f®tu+ssee,cutiar rA Pnitty numbu ue:
P'4.7 Nay,, 1 Fi
C'.13RERFATB of G%FlilP'pw FRt m WEER,
CG`th MISMON INSURAW"11I
x�y('fhlt vCtiartnEalsc+t►eae�knpietea it asr prsmk H rtx aimbonlitnd dditnlsi(16)
1 txrtfy&I in the purotalages a'#4 work fa whkA this pr:oul is issued,l Mali A
ranploy eny parson n shy nett MW w u so beco"ro4kct m d.'yrkkra Con rnwtlost
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NOTICE TO APPLICANT:If.efwt wAIRS this Conlf�asa o: __fn "
become A bjeet in the WakcOs CamrtaWWQI I;"Uliow of the Ltpw rode,you hast
Qrorthvrith twsidy wkh ach f4twilWo a this pernk shat!be thaws !avow
4 r%} CANSTRUC'BON .BNDIM;AGP-NCY
1 k ithy&Mrm iW okw i s t asnuuv'tfna lakdi.rl W ray far d<porfsrmatsq of
!.> the wtxt for tylh:h"permit tt fawf3oc.W.Civ C..y
Lendrrs Ntara
U O 1 aeify that I have and ttb V*iiticm and Auto the W ibove Iefhwnst,urr M
iL t! Como.I Agree to o mply*iLh ail Clly Nd 00"ty e�Amm&,A Alae IA*.tewinf to
(� buitdfnica�fuitosian,sndhsrobytpakpiae.epr"fPWivxoidiuchytoanterupnar:r,
iJ2 Ahow-maw"Pmwy for Inspo "wpm$.
(k)ASlee W awe:J111k mnify VA kasp haw w the ruy or Cvjw*n t strut
rwr f� 111wiltics,!wtSme+nts,calmdvxPss IWMChrnsymAnpw.y",asshutwi4C'i(y
V In••rtttyww"nt the of rho prtmtt.
APrK.ir hT U,a DS AND WILL COMPLY W)TN ALL NON•POItvT Issued by, Bate
sur'
r'.. .�_... � ..�.._ Re-roofs
si a UCanunctos
HAURC*V$MATWIAIJ DISCt.osuae 'type of Roof
Wtn IAe appik'wn a ruuuo bstbhia oc"�u car@ ar hkwk!yrw*m niatertr1
u do fined by dx CUPKINo Atftutclyof Cods.Cfi"9.32.ped ds Haahh sad Snrvhf
Cak,;WIN U5324s)l
twat ci No All roofs shall be 9ntspected prior to any roofing material being installed.
Wl ittk Applkmeor futtift t`AWmS ooe(�snt urs 44WPnrm at,devim wlik•i, If a roof is installed Withot;t first obtaining an inspec.iion,l agree to ra move
emu Asru4nw air eana6'Ift- s u dnRsed by tas City Avas A.t Wky MmWm m
Diutir•t7 , ItIE now materials for Tnspect;an,
�I war �j No
I hnz mad the hamilt-s matcrisit tequttrmettt under Cheptr;.4S or dx CilelnP
six l h alih&Wcty CW9,kcUww 25P.25533 AM Z3t3s E uxknw ow i!ft bwWlttff
daea•,a canantty havo t"A It is nay respotoflulity kt notify dm ntsupw M tfse
ukcr+iemi wh ch Must a to awmo Of I cav ksir of Occ
i Sij�nature of Applicant — Date
IOwncr yi'tT�ni a rn ���M "s All foof Ct)1'Cfinf'::Sn ttC ii15S ef I'Cft4i
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