HomeMy WebLinkAbout2808 ROOSEVELT ST; ; 77-10149; PermitMODEL ~.O. _________ _
BUILDING PERMIT APPLIC TION
City of CARLSBAD, CALIFORNIA 92008 -..
re A pp I an C u r t ro omplete n mbe ed spaces only Phone 729-1181 Permit No
J08 A OOR [5S ASSESSOR'S
'J-. 8€J g C:_ ( .. / ' /~--PARCEL NUMBER
C
LOT NO. I OLK
I T .. CT BOOK PAGE I PAR,
LCCAL I tOsEE ATTACHED SHEET! 1 0£.SCA. '// ... C
OWN E." MAIL ADO,il:[55 2 .. C r · PMONE -
2 ....t. -, ./ K/ -0-I ... ) 7' . I ,
CONTIIIAC:TOIII MAIL ADDRESS PHONE STATE LIC, NO. CITY LIC. NO.
3
ARC~ITECT OR 0£5\GN CJII M AIL AOOAC55 PHONE LICCNSC NO.
4 4 n \-" -I ("' I y . .
CNGINCC'I -M AIL AOOACSS PHONE LIC[NS[ NO.
5
COMPENSATION INS. CARRIER MAIL AOOl'tCSS . BlltAN Ct-t _) _T
6 /-; i,_ / ,.. . . -
use o,. eun.01NG "
1 / --';:)
( I" NO. BDRMS NO. BATHS -
8 Class of work: □ NEW □ DDITIOJQ ,}J;L TE RATION 0 REPAIR □MOVE □ REMOVE
'
9 Describe work: I ~ i'J (_ C. ('~ \ -r ,,.-C F .. ,_ rs ✓{ '(_ / '
, I {. ~; I -r r-r /., r V ( ,. .. _,
10 Change of use from
Change of use to .-.-~~ I (J 11 Valuation of work: $ A 77 r; s PLAN CHECK FEES/. 7 7<?" PERMIT FEE$ /r ,I
SPECIAL CONDITIONS: MICRO FILM FEE
Type of I Occupan/y ,,
Const. Group .,,,. -~ { t ~12h\ft9P.c ,9 N o. of Max. ///
f _h'l.•'· (Total) S . . I Stories 0cc. Load
F ire -, Use '1 Fire Sprinklers
APPLICATION ACCEPTED 81V PLANS CHECKED BY APPROVED FOR t$SUA~E. BY Zone cP Zone --Required 0 Yes □No , OFFSTREET PARKING SPACES:
/ .fl' 11 No. of !No. ,) Dwell Ing Units No. DATE D ATE Covered SQ. Ft. Open
NOTICE Sp ecial A pprovals Required Received Not Required
SEPAR ATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-PLANNING DEPT.
ING, H EATING, VENTI LATIN G OR AI R CONDITIONING. HEALTH DEPT. TH IS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHOR IZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SU SPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY T IME AFTER WORK IS COM-
M ENCED . OTHER (Specify)
I HEREBY CERTIFY THAT I H AVE READ A N D EXAMINED THIS ENGINEERING DEPT. APPLICATIO N AN D KNOW THE SA ME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS A N D ORDI NAN CES GOVERNIN G THIS WATER DEPT.
TYPE OF WORK WIL L BE COMPLIEO WITH WHETHER SPECIFIED
HEREIN O R NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO G IVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION S OF A N Y OTHE R STA T E O R LOCAL LAW REGULATING CONSTRUCT ION OR THE PE RFORMANCE OF CONSTRUCTION.
51GNATVIIIE o, CONTlltAC TOIII 0111 AUTHOlltllED AGENT (DATtl
51CNA TU11tr o, OWN[ .. 1, OWN t lll ■UILO[lltl ID.ATC)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CA SH PERMIT VALIDATION CK . M .O. CASH
~
T OT AL FEES $ _ _.2"--_._7 ____ -__
INSPECTOR
INSPECTION RECORD 77-10 , '-19
DATE REMARKS INSPECTOR
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
FINAL
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
u
MODEL NO_. ______ __;;_ __ _
BUILDING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Ap rcantto complete numbered spaces only Phone 7 29-1181 Perm 1I No Pl -JOS ADDA ESS
fL'tA-~ ASSESSOR'S
~~ ,</MJ''3"Y5t-T rrr L:~i.J~ 17, PARCEL NUMBER ;
LOT NO. I ILK I TR: CT
e....,....,K PAGE I PAR.
LEGAL I -~-· 4;3~ /~~'-"1 ) (qSEE ATTACHED SHE)TI 1 O[SCR. v ..... , , . .> . -OWN CR MAIL ADDRESS & ZIP (..,-~ ""Of"/~"' ~ { •~ 2 / ,.. ... .1: ~ ~ .ttf ~_,O"V 1-; V. .t__d2.t /::.:.6 ~:(~ --29---~'°'?' 1 ""-i --~' r, ,'_l,
CONTRACTOR MAIL ADDRESS PMON E STATE LI~ NO, CITY LIC, NO. . -3 I I~ I
A.AC11ITCCT OR DESIGNER MAIL ADDRESS
~~j/4,f,~J
PH0t;'£ 29-/ .. ,.,,..:..:,)c,cr .... "'?" ,;;.~
4 r} .:: --'-✓ , ?tA.~J?; . .. _, l ,I -· ..: ( . -~M , -J ~ .... , .,,, --4-:... I -(//411'~ ,, ~ --,L ,.'7"' l .. -£.NGIN CCR M ... IL AOOA[SS /Zt;;~O PHONE # ~-L/4~NO.
5 1 u -r .:.... -
COMPENSATION INS. CARRIER MAIL ADDRESS 8RANC"4
6 1---, (? ,,,, ....
US£ o, BUILDING ~ .. ~--f~~ 7 0 ----., ,. NO. BDRMS NO. BATHS
8 Class of work: □ NEW 0 ADDITION O~TIO N □ REPAIR □ MOVE □ REMOVE
9 0 escribe work: .. -,,. ...;,__ _'..,, l /# ._.;::;,, -; -~ (.... /. = #L?-
'?/LI/I..A O /U.fV/_f/, c ·C'Mll:l •. :o-t!..T ttJJ/t:A-17"~0 /Z.. ~a.{ .,, ~
-,r ,-.,-7~ cf/4../(:..K ,u',,,;f/n-::::z_J ~
10 Change of use from i C) (..;/':,.';? -ti€
,-
Change of use to -117
Valuation of work: $ ~~t:>tf.)0 llf~· l #0 , ••
11 / PLAN CHECK FEES PERMIT FEE S I J
SPECIAL CONDITIONS: , .. MICRO FILM FEE Type of 1 ,v Occupancy
Const. _Ji, -Group
Size o f Bldg. No. o f Max. /2t> .. ~ (Total) SQ. Ft . Stories 0cc. Load
Fire Use C. Fire Sprinklers
APPLICATION ACCEPTED 8~ !,l'LANS CHECKED 8 Y APPROVED FOR l~UANCE BY Zone ~ Zone ReQuired 0 Yes □No
OFFSTREET PARKING SPACES:
_,/ I/ fl No. of JNo. Dwelling U nits No. DATE DATE Covered SQ. Ft. Open
NOTICE f Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR E L ECTRICAL, PLUMB-PLANNING DEPT. /
ING. HEATING. VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC· ,,,,
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGIN EERING DEPT. 7 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS WATER OEPT. . TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED l.l .. 1:· r. HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT :r . , .,,) f I /') PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE I PROVISIONS OF AN Y OTHER STATE OR LOCAL L AW REGULATI NG CONSTRUCTION O R THE PERFORMANCE OF CON STRUCTION. .,)Pl.,t.-I
,_
51GNA.Turc 0,-CONTIIIA.CTOIII 0111 AUTH011111[0 AGtNT 3.:;;;:>• 17 .,. I' ' f '-::Z. ~~
J t. tv'V . '
SIGNATUtl[ •,.. OWM'[,_ft 11"-0WN[III eiJlt..t)[ft) (OAT ti
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M .O. CASH
T OTAL FEES $ _____ J'_' ___ _
INSPECTOR
INSPECTION RECORD
DATE REMARKS INSPECTOR
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING . FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
FINAL
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
See all inspections in enclosed envelope.
PLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Perm it N,o 7 7-/ a / ..J -( J
J OB ADD,t CSS
;:, ( 0 (' r l..,c.
I LOT KO°:"' LEGAL
l ouc~. -, / V /? I TIIIACT "-
( ( .... ... · ~ rf (' .... I /}7 r,.J
OWNCllll , -( I MAIL A00Jlt£55
2 jf ,,.,f.._-~ .,
CON '11!AC TO,_ .... MA I ll,...,A0011ttss
3
AIIICMITCC'T OJI t>CS)GNtft MAIL AOOIIIC55
4
(NGIN[Cl'I MAIL AOOfU.55
5
lr,,,IAIL AOOJll:[55 COMPENSATION fNSi'CARRIER
6 -, ~ Cr,.,... //,f:""
USC OF BUILDING
7
8 Class of work : □ NEW gA□DITION (RALTERATION
9 Describe work:
SPECIAL CONDITIONS:
APPLICATION ACCEPTEO eY PLANS CHE CKE O BY APPIIOVEO FOil •SSUANCE BY
DATE -NOTICE
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION ANO KN OW THE SAME TO Bf TRUE ANO CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
r I /})1 ~ // •, • / , c_ r ,z_;__ .... _/~I£..
,41:fCNJ.TUAl OP"' COHTAACTO"'-OA AUTMOllll?tD AG[NT (DATL"I \.
(O•Ttl
.... ,,,,.-,,,.. ..
PMON [. '-' STATE LIC, NO.
PMONC l.lCENSC NO,
PHONE LICENSE NO.
lll"ANCH
□ REPAIR
PERMIT FEES
No. Type of Fixture or Item
WATER CLOSET (TOILET) -BATHTUB
LAVATORY (WASH BASIN)
J SHOWER
1 KITCHEN SINK & DISP.
I DISHWASHER
I LAUNDRY TRAY
CLOTHES WASHER
I WATER HEATER
I URINAL
DRINKING FOUNTAIN
c; FLOOR-SINK OR DRAIN
SLOP SINK
/ GAS SYSTEMS: NO. OUTLETS ~
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER NUMBER CLEANOUTS
CESSPOOL
SEPTIC TANK&. PIT
I ROOF DRAINS
ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
. -
CIT Y LIC, NO,
Fee
$;,' i,-,;.:-
,.·~--
f
/ -
I
/
; )
-, -.'
,I ' -
I ..>
CASH
ELECTRICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. Phone 729-1181 7-A :.r..:j -JI•)~"~~
Perm it No. _ /· / tf
JOa ADO,. lSS
~Bt:>8' ;C_ZJaS€Jez..T sr, e4.-cW.d41~ e,.e;. 92tJi78
I LK
COH T,.AC TO" CIT Y
3 ,(, il/t-'~
AfllCHITCCT 0111 DISIGNUt
1.NGINE[ft ,-J. 5 • {~
COMPENSATION INS MAIL AOO .. ESS
6 (./ I f
USC o,-8UILDING
7 qr)
8 Class of work: □NEW [11--AOOITION 91('(rERATION 0 REPAI R
9 Describe work: ,, c:!="L.c::t::';9~
PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS:
ISSUANCE OF EACH PERMIT C II
~ NEW CONSTRUCTION, FOR EACH
APPROVED FOR issuA~(Jiev . _A_M_P_E_R_E_s_o_F_M_A-IN_s_E_R_v_ic_E_, _sw-1T_c_H_,-+---+---+-----+----1 ~ FUSE OR BREAKER
1---------"----------'.:;D,;;A:..;.T.;;E ____ _.;.;..-f NEW SERVICE ON EXISTING BLDG.
AJ't'LICATION ACCEPTED BY: PLANS CHECKED BY
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYb AT ANY TIME AFTER WORK IS COM,
MENCED.
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCE!> GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA. AMPERE OF
INCREASE
TEMP. SERVICE UP TO AND INCLUD·
ING 200 AMP.
TEMP. SERVICE OVER 200 AMP.
PER 100
PERMIT FEE
V WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK.
INSPECTOR
• 5
7 '' ,
M.O. CASH
ELECTRICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Permit No 17-/ e,, S-91/
JOB ADDRESS
'ConS, eve, 1 ::15'()?( I LOT NO, I BLK. I TRACT <OsEE ATTACHED SHEET)
•s-LEGAL 1 DESCR,
OWNEt", ~ h, v,:,-\,Vt \ S. u t1
MAIL ADDRESS ZIP PHONE .:) ~~7 2 l C 8,"'"1-u...:-( 1( ' h,:,, I 7 ;;c, ' 3cojA~be I' _,,,..,+_ MAIL ADDRESS
\ I/IA t/v,1~.,. -'l
PHONE STATE LIC. NO. CITY LIC, NO,
~ \.·"") 1-I~---_,...,. .I /'J.'131
ARCHITECT 1fa DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO. 5
COMPENSATION INS CA~R MAIL ADDRESS BRANCH 6 ./-_ . -1 " 'I/ I
USE Of BUILDING
7
8 Class of work: □NEW 0 ADDITION ~LTERATION 0 REPAIR
9 Describe work: --\ -,,
!\ t ~,-t ... -
\.... { ... \L"'\ r l o f ,-I .
PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS: SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
ArPLICATION ACCEPTED BY 'LAN$ CHECKED BY APPROVED FOR ISSUANCE BY AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
d {J DATE NEW SERVICE ON EXISTING BLOG.
1 NOTICE FOR EA. AMPERE OF INCREASE IN MAIN SERVICE, SWITCH, FUSE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC· OR BREAKER
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM REMODEL, ALTERATION, NO CHANGE -tr) MENCED. IN SERVICE, FOR EA. AMPERE OF 5w I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCE~ GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO ANO INCLUD· PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ING 200 AMP.
\, -l . ;:-~,,; t "2:)
TEMP. SERVICE OVER 200 AMP.
PER 100
ilic:-
SIGNATUjft Of CONTRACTOR OR AUTHORIZED AGENT (DATE)
~( '·(.) ISSUANCE FEE
TOTAL FEES -~? ( ,.
-.11::.NATURE OF OWNER IF OWNER BUI DER DATE ) ...
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
7 ~ I INTERDEPARTMENTAL INFORMATION SHEET
......-r:~D ING DEPARTMENT
LDING ADDRESS:
RECEIVED
DATE: ----s-E p--'2-7---· 1-97_7 _
I
NNING DEPARTMENT r;1aLJ+11 7 <oS
CITY OF CARLSBAD
BuUding Department
NE _________ LOT SIZE ________ LOT WIDTH ________ _
NITS ALLOWED UNITS PROVIDED ------------------------
\RKING SPACES REQUIRED PROVIDED -----------, 1 COVERAGE ALLOWED ____________ PROVIDED _________ _
BUILDING HEIGHT ALLOWED PROVIDED ----------
FRONT SETBACK: SIDE SETBACK: REAR SETBACK:
ALLOWED ______ _
PROVIDED ______ _
INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
\t NVIRONMENTAL PROTECTION REQ: e~±:•
ADDITIONAL COMMENTS:
•
RE DEPARTMENT (:'. D.
Rll◄KLING SYSTEM ___________ FIRE PROTECTION EQUIP. ______ _
'f'E ALARMS ______________ EXITS_4'o~..__,,.c£,c..lj-1'1:l_..,rhe:,,,,... _________ _
~E HYDRANTS __________ LOCATION _________________ _
DITIONAL COMMENTS L~~;:0•:---~-p~k,
I~ /lM--&➔ (t_(~---~ ~ ~~ .. ~.. 1,!_~~flO••* p ~ 0 1 "''
ro ISSUE =Gu~-&J~TE {o ~ l;7 -11 OK TO FINAL OK, DATE ___ _ . ~~so
WATER DEPARTMENT -.
REQUIREMENTS OF APPROPRIATE DISTRICTS MET ________ DATE _______ _
7
'
r;.1-,,_ .. ::ra·_:•~;c(;..:..;;--,;;;:"--~~ ;J;J:..._;..••'"'"P'lf:t•:::
~ ._-;,, ~.,,.-=--_-::' . .:.., -•--•.~r
,:
)l( MAAAAM~AAAMMIAt:Jil,.AAA/AA1.'VAA /A~vMJA.JAAA/A/A~ ~ 1 ~ ? 3 QI 1\ rt if i r u 1 r o f ® r r itµ u tt r y · -~~~,. E
~ ? ~ CITY OF CARLSBAD :
~ ~ ~ This Certificate issued pursuant to the requirements of Section 306 : i of the Uniform Building Code certifies that at the time of issuance t
~ this structure complies with applicable ordinances of the City P 3 regulating building construction use. ~
j Use Classification. RESTAURANT Bldg. Permit No 77-10149 ~ ~ Group B-2 Type Construction V-N Fire Zone 2 Use Zone_ ......... ____ t
~ Occupant Load _...._........_,,,-:,..-.,,.-.._-__.-u -:_,,_-_..-,..-,,_,-;L---'----_-:_---~--.::---..-~-:..-~-~-~-.,,-..,-~-... -_-._-:__-_-_-_-_-:_,-_-_-_-_-:_,-_-_-~ ~ ,~ .. "'"""·~~ ::: ~~-~ . ~ ~ ,< .. ;,.,,~ •• :-.LCh < ,-:~~::= Jt:: ~ ~ · l·",·''"•<·'·1,· .... -•' ·. · i ·· ... .o···, ~
~ ---------------~-!.!:.~±:!::::=::::==-~ ~ B t ~ . . . Dote April 5, __ 197_8 . ~
A NOTE: Alterot1ons, changes, odd1t1ons or chonges of occupancy null.fies thtS certtlicote. , ~ » ~ (Post in conspicuous ploce) ~
)(ffff M M ,, M M ,, M M M M M M ~~'rW"f/W"/f"l(/V/fffffff/'r/"o//"ffo/X
··--. ·--------·