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1986, 12-09 Permit: 00014453 Woodstove
SIGNATURE OF APPLICATION OWNER OR AGENT DATE JOB ADDRESS OWNER: ADDRESS: CITY: tt:t. ST: ZIP: APPLICANT: CONTRACTOR.: ADDRESS CITY: ST: ZIP: PH: LICENSE*: ARCH/ENGINEER: ADDRESS: CITY: ST: ZIP: PARCEL*: CENSUS TR: INSPECTOR: PLAT*: LOT & BLOCK FINAL PLAT NAME ZONE*: ZONE FSB 5-1 5 - 2 RSEI MOD USE OF PERMIT: JOB ADDRESS: PROJECT# SER. *: DATE: FEES: PAID BY: COUNTER APP.: PLANS EXAM: DATE: I , . . ":,:•t; 0 1 :I. t1:1: t.t t:Et .t. t7t.1 P - A A; 7 ') 1 r".