1986, 05-08 Permit: 00010901 InsertSIGNATURE OF
OWNER OR AGENT DATE
APPLICATION
JOB ADDRESS
RD
OWNER:
ADDRESS:
it
RRD
CITY: 5T: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PH: LICENSE.:
ARCH/ENGINEER:
ADDRESS:
CITY: 5T: ZIP:
PARCEL.:
CENSUS TR:
INSPECTOR:
PLAT.:
LOT & BLOCK
10I
FINAL
PLAT NAME:
ZONE.:
ZONE
F55
5-1
00
S-2
000
555
MOD
PLANS EXAM:
USE OF PERMIT:
JOB ADDRESS:
RD
PROJECQ
SED. x:
001205;..
DATE:
05/00/86
00010901
i::ci-t NIDAL. $25,00
FEES:
PAID BY:
CA
CK
CG
NC
COUNTER APP:
$
PLANS EXAM:
DATE:
MECHANICAL PERMIT
F1IH: HAN1CAL TOTAL. FEE
• AH'L..: Dry a Range 0 Gar, Log 0 1,. W/Fl 0 olid Fuel 01 Fe
FUEL._ SOUR L: Electric N Gas IRI Oil N Coal N Wood Y Solar N
IBUTION: Forced Air N Radiant `y` Heat PUMP N
Processing Fee
(0/0
$25,00
10,00
15,00
3
INSPECTOR'S CODV
0
I NSP—I D
DATE
0
0
J
co
1 1
0
w
2
514
w/3
-_ W
00 2
2=
0
0
J
W
cc
2
N
ROJECT FINAL
1