1986, 12-11 Permit: 00014492 WoodstoveSIGNATURE OF APPLICATION
OWNER URAGENT DATE
JOB ADDRESS
`
"""=
^~~^~"^'
^S�86 E `�� '- ur
".``. ST: ".,.
`' ,a
^"^""^°`'
CONTRACTOR:
~~~"~"^'
"IT,. ",. ",.
,°. LICENSE*:
'''24-03::: -
"="'"",.°EE".
,,",E=
".``. = ZIP:
,^.==
`24O4
CENSUS TR:
."","",°".
"`=~'
' '0
LOT & BLOCK
FINAL
PLAT NAME:
~~~~..
ZONE
=.
5 1
5 2
RSB
MOD
"""= PERMIT:
'°°°==°"""'
PROJECT#
DATE:
FEES:
PAID ^`'
"
COUNTER APP:
~`""°"""M'
MECHANICAL. .:'ERMIT
MECHANICAL OTALEE
HpyL; Dry 0 Range 0 Cas Log 0 Gas W/H 0 Solid Fuel 01^ Fee
•
FUEL SOURCE' Electric N Cas N Oil N Coal N Wood Y Solar
DISTRIBUTION: Forced Air N Radiant Y Heat Pomp N N
Processing Fee
$25.[F
10,00
15.00
17-11� -E 6 6 7 68 �2 5.00j
riccnt+c rtneyk
INSP-ID
DATE
/9(
x
U
W W
m 0
0=
0
w
O
O
-J
LU
CC
J
w
O
cc
1