1993, 01-05 Permit App: 93000025 Gas Log PipingJOB STREET ADDRESS: S
CITY/STATE/ZIP: Sps, K ,
OWNER: TDS_21
1.
MAILING ADDRESS:
•
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
qy/3 &;iis c�-
93- oz5
1521
4
W & ¢ ..z;e6 PARCEL NUMBER:
T hi ) i\Q3 PHONE NUMBER: l
(Street)
(City/State) (Zip)
CONTRACTOR: f ) C : Cf M1 sc�r'�hl C E FAQ LICENSE NUMBER: 141 IC -C (/!