1986, 05-29 Permit: 00011276 Spa HeaterSIGNATURE OF APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS PROJECT
SEP.
DATE:
EES:
PAID BY:
G
N
COUNTER APP:
PLANS EXAM:
DATE:
MECHANICAL rERmIT
MECHANICAL TOTAL. FEE.
GAS PIPING SYSTEM: Quantity 01 - Fee wi
•HF:: (T SYSTEM ( T U) 1 0 0 K or Less 01 .Over 1is { K 0 Fee Sr ,
FUEL SOURCE: CE : 1 lectric N Cas Y Oil. N Coal. < Wood N Solar N
Processing Fee 5
INSPECTOR'S COPY
U
OWNER:
ADDRESS:
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PN: LICENSE*:
ARCM/ENGINEER:
ADDRESS:
CITY: ST: ZIP:
PARCEL*:
CENSUS TR:
INSPECTOR:
PLAT*:
LOT & BLOCK
BLOCK0 0,
FINAL
PLAT NAME: k 1 ADD
ZONE*:
ZONE
FSB`
S-2
RSB
MOO
;.TIER i'IP1Nca
USE OF PERMIT:
JOB ADDRESS:,., ff N' ` L, W r
SEP.
DATE:
EES:
PAID BY:
G
N
COUNTER APP:
PLANS EXAM:
DATE:
MECHANICAL rERmIT
MECHANICAL TOTAL. FEE.
GAS PIPING SYSTEM: Quantity 01 - Fee wi
•HF:: (T SYSTEM ( T U) 1 0 0 K or Less 01 .Over 1is { K 0 Fee Sr ,
FUEL SOURCE: CE : 1 lectric N Cas Y Oil. N Coal. < Wood N Solar N
Processing Fee 5
INSPECTOR'S COPY
U