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' ,,~ ' " PHONE: 588-5147 8:00 - 4'30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> i am performing work an a property I own or occupY, __~ <br /> I ~m a registered builder OR the authorized represet~tative SI~NAT[JR~ OF Ai:~LICANT;~ <br /> 0 a registered builder, <br /> The work will be performed by a registered builder, <br /> Other <br /> <br />~ K,t': M<d'-~Tl'i>!,, PA'! ?,,o,a. S8 ~ REZSZ[BENTZ'AL <br />......................................................................................... L <br /> <br /> HO. CEFJTi~]:< <br /> <br />fWIDTN: [DE~N: ~, AREAZ UNITS: I IRREG. ~OT; <br />, , · ~-.,,~8 , Al. i NO , I~0 <br /> <br />TYPE: ~fANUF'ACTURE~) STROCTIJRE PERMIT OR APPLICATTDH NO: <br />,COfl Tf,~AC FOR. NO,. <br />KII,MARTIN~' PAT <br />2l~4 Nf.), CENTER <br />SgBi..Tf.': TY 97385 <br />PHOI',IE ~: 769.-75~6 <br /> <br />HANU~,AC'R,IRE~) STRUCTURE: STATE I:I~E <br /> <br />HAI,IUFACTURED ,,TkU~ TLR <br />KANU?ACTURED ¢ ....... '" '~Rb .... ' .... " ....... <br /> olR ~CIl,d: <br />(<¢d'tLff'ACTURED S f IdJC I LIRE C( ~B D/W F't,18l_.(C WORKS <br /> <br /> IOTAL ,A ~,~E<~SE~ FEE,. <br /> :: : ~REV <br /> <br />Pi;'CI;']'VF'D i(¢¢: om <br /> <br />90580~9 <br /> <br />$2~3.60 <br /> <br />$0.80 <br /> <br />I- ECEIf I 6~¢566 <br />CI,,E[6 K ,~:; :L262 <br /> <br />FgLLOWtNG MUST BE COMPLETED, IT ZS THE' RESPON~ZiIILITY OF THE APPLICANT TO ASSURE <br />THAT ALL ~ECESSARY <br /> <br />~ORM # MC 15,5e REV, 4mo OFFICE COPY <br /> <br /> <br />