1986, 10-07 Permit: 00013492 ReroofAPPLICATION
DATE
PROJECT „-
SEQ. #:
DATE:
SIGNATURE OF
OWNER OR AGENT
JOB ADDRESS
Building Code fee
:WILDING
PRIMARY STRUCTURE:
ECONDARY STRUCTURES
STRUCTURAL_
FEES:
PAID BY:
COUNTER APP:
PLANS EXAM:
DATE:
IMCDC('Tr D'C ('(IDV
TOTAL FEE
TOTAL. FEE.
Permit Fee
4 i
OWNER:
ADDRESS:
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PH: LICENSE#:
ARCH/ENGINEER:
ADDRESS:
CITY: ST: ZIP:
PARCEL#:
..,. I.,.
CENSUS TR:
Ii '..''yliil:
INSPECTOR:
PLAT#:
LOT & BLOCK
FINAL
PLAT NAME:
ZONE#:
ZONE
[fl,!
FSB
5-1
5-2
RSB
MOD
USE OF PERMIT:
JOB ADDRESS:
r- a:,Uo; is AV
Building Code fee
:WILDING
PRIMARY STRUCTURE:
ECONDARY STRUCTURES
STRUCTURAL_
FEES:
PAID BY:
COUNTER APP:
PLANS EXAM:
DATE:
IMCDC('Tr D'C ('(IDV
TOTAL FEE
TOTAL. FEE.
Permit Fee
4 i
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