1986, 06-20 Permit: 00011714 ACPROJECT #
5E0. #:
DATE:
SIGNATURE OF
APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS
MECHAN1:CAL. PERMIT
FEES:
• 0 0
PAID BY:
G
N
COUNTER APP:
PLANS EXAM:
DATE:
TOTAL FEE
1:0MpRE:rshOR ; 0--3 01 3-15 0 15-30 0 30--50 0 Over 50 0 Fee
FUEL SOURCE:: Electric N Cas N O:i.1. N Coal. N Wood N Solar N
Processing Fee
f.‘•.
INSPECTOR'S rnov
$24,00
9.00
15;.00
'yV u
0
OWNER:
ADDRESS:
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PH: LICENSE.:
ARCH/ENGINEER:
ADDRESS:
CITY: 5T: ZIP:
PARCEL.:
CENSUS TR:
INSPECTOR:
PLAT.:
LOT & BLOCK
FINAL
PLAT NAME
ifND ADD
ZONE.:
ZONE
FSB
5-1
5-2
5551
MOD
USE OF PERMIT:
JOB ADDRESS: ++.. i ji``
MECHAN1:CAL. PERMIT
FEES:
• 0 0
PAID BY:
G
N
COUNTER APP:
PLANS EXAM:
DATE:
TOTAL FEE
1:0MpRE:rshOR ; 0--3 01 3-15 0 15-30 0 30--50 0 Over 50 0 Fee
FUEL SOURCE:: Electric N Cas N O:i.1. N Coal. N Wood N Solar N
Processing Fee
f.‘•.
INSPECTOR'S rnov
$24,00
9.00
15;.00
'yV u
0
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