1986, 12-12 Permit: 00014517 Wood StoveSIGNATURE OF
APPLICAJ
OWNER OR AGpT _ DATE
JOB ADDRESS �JJ
MLLHANICAL PERMIT
PROJE•
SEG. *:
OATS:
•
FEES:
PAID BY:
CA
CN
CG
NC
COUNTER APP;
PLANS EXAM:
DATE:
TOTAL FEE
;range 0 Giis Log 0 Gas W/H 0 Solid Fuel 01 Fee
°"IAEL SOURCE: Electric N Gas N Oil N Coal N Wood Y Solar N
5TREBIJTIOt' Forced Air N Radiant Y Heat Pump n!
Processing Fee
-
INSPECTOR'S COPY
$25,00
10,00
1:;.00
•
OWNER
ADDRESS:
[el)
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
RD
CITY: ST: ZIP: ,.I 0 LL
PH: 1 LICENSE*:
ARCH/ENGINES R•
ADDRESS:
CITY: ST: ZIP:
PARCEL*: ICENS'JS TR:
INSPECTOR:
PLAT*:
LOT & BLOCK
FINAL.
PLAT NAME
ZONE*: !ZONE
PIM
11-1
S - .
RSB
MOD
a l .,,KALI
USE OP PERMIT
JOB ADDRESS: •+.I,
MLLHANICAL PERMIT
PROJE•
SEG. *:
OATS:
•
FEES:
PAID BY:
CA
CN
CG
NC
COUNTER APP;
PLANS EXAM:
DATE:
TOTAL FEE
;range 0 Giis Log 0 Gas W/H 0 Solid Fuel 01 Fee
°"IAEL SOURCE: Electric N Gas N Oil N Coal N Wood Y Solar N
5TREBIJTIOt' Forced Air N Radiant Y Heat Pump n!
Processing Fee
-
INSPECTOR'S COPY
$25,00
10,00
1:;.00
•
INSP-ID
90
DATE
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_AIS a
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