1986, 10-22 Permit: 00013790 Wood Stove SIGNATURE OF _uiAPPL|CAT|m� /A _� T /
OvvNERORAG= ' / ` etad-A- �� - DATE ` '� '�m' �(�
?A-6d
JOBADDRESS � PROJECT#
6411 0TH
5tr0/5318 =`~', 8/22/86 0001379D
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WOO OS TO V E:
$25 . 00
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MECHANICAL PERMIT
iMELHANILAL TOTAL FEE $25 . 00
APP[ : Dry ..0 Range 0 Cas Log 0 Cas W/H o Solid Fuel 01 Fee 10 . 00
FUEL SOURCE : Electric N Cas M Oil N Coal N Wood N Solar N
Processing Fee 15 . 00
7O - 27 -R6 5871 * 2 500u
OFFICE COPY
• ".41 71
°PROJECT
FINAL El SIGN RELGC DEMO MOB
B1E MECH 17-BG BLDG 6-
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