9720 SW WASHINGTON SQUARE l
9720 SW Waahira3ton Square
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``"M'T " APPI_ICATIO'NJ FOR BUILDING PERMIT GREEN Temporary rile
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WASHINGTON COUNTY uI sr Ile(•) _5_ (1/ 24�/ S9 e!1
DEPARTMENT OF PLANNING ,
BUILDING DIVISION f �JJ ar
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NO uir GEour TYPE PP S BI
�1 72 LOR APPLICANT TO FILL IN .V 1 "I ` �_.cONST ��
BUILDING /J�u _ ETA ISTICAL CLASS'PIr ATION 'TINE
ADONESS�/7.119/JV(Jt)� _5G L A. I CLASS NO _—ONE L L J NI 13 __�_.�-_..
LE G►L L,EYCHIPIIO^. 4.5 /-4,24 C ' SPECIAL CONOi11ONs
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USE OF illi IONiNG AFP"L•vio SY - ,. I e/2/7,3
EXISTING ALOO
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AUCYHITEC_f 111 1.LS T /L' IA/
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ENOINEE"��V71 J/1(fftr NTFC L A'/'l 'RIEMt1'Av 4,110TM /ROAD: .
ACIDNESS `A/111:-. `
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ADU"•.SSf,1 L',/ild</V C'1- MI/AWA WIOTM ?SOU
CITY .1,LC 41 L. / / L , +
DESCRIPTION OF WORK co.' *EcJTOPP IFS C NO C
NEA i AOC ALTER REPAIR DEMOLISH SEE REVERSE SIDE FOR SPECIAL APPROVALS
SO r" NO nr NU O•
i�?FJ_ 1' C !TORIES / IAMI LITS
RE ONOOMS NO. OF PA",Pnn••,
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APPLICAI,T APPROVALS :`AfI .M11.E0'00 TA'3MATURE
T ! I • , IDEATION
VALVA ION (• ...] •00 . a•• .�A,!.,Ci ACLS _
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✓E E S FEE S REPLACE
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AM0 STATS THAI THE •A011r MA <nRRe:T AND Achill YO CONN v ,SAIL BOARD
W I1,. All COUNIT OPDINANCCA •NO S'ATr LAWS REOUL•tIN-. ,----
Su1LO•NO CONETRUCTrO"
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SIGNATURE OP / .• �. ',l 'I r'RfR I"uu1
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