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INFORMATION APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATLON; THAT THE
OR T IE DULY AUTHORIZED AGENT OF T�,j,0,p.,:_ It . pj, d Big— by
GIVEN IS CORRECT. AND THAT I AM THE OWNER,
COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG CALL 9 -lb., D.PuIY: tt�d F p1d,
THE OWNS R. I AGREE TO
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RELATI G TO )R INSPECTION
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IN OF THE LABOR CODE OF TH DATE
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NATURE (:C: . A. NTI
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771-0220 ELEASED 0 E
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i A17ENTION
U PY A BUILDING OR STRUCTURE UNTIL 771-0221 YELLOW INSPECTOR
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HAS BEEN MADE AND APPROVAL 0 R A CERTIFF ORIGINAL FILE
OWNER GOLD -ASSESSOR
A FINAL INSPECTION K
GRANTED. UBC SECTION 109 FAX PIN
CATE OF OCCUPANCY HAS BEEN
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