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1984, 05-08 Permit: 00001095 Plumbing Fixtures
SIGNATURE OFee' APPLICATION (re 67' OWNER OR AGENT DATE JOB ADDR.E 5I:C1 T • ZS �� SEQ. #: DATE: PROJ#: OWNER: M/16C0 ADDRESS: CITY: ST: ZIP: APPLICANT: CONTRAC60TOR , mettc44- f WC- ADDRESS: • CITY: ST: ZIP: 19016.1%) WAG PH: ^� , 12,3 LICENSE*: ARCH/(-ENGIINE1_ �rER: ADDRESS: CITY: ST: ZIP: PARCEL#: CENSUS TR: INSPECTOR: PLAT#: LOT&BLOCK FINAL PLAT NAME: ZONE#: ZONE FSB 5-1 S-2 RSB MOD USE OF PERMIT: FEES: • PAID BY: CA CO NC JOB ADDRESS: COUNTER APP: PLANS EXAM: D2:�:R �V s 4 '1 • 1- k . S - 2 Z - UNA) L - - S • i - fiu1 0 0 w 0 LL LL 0 0 -0y �58s--84 406. 25 *46. 0.0