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1984, 05-08 Permit: 00001105 Plumbing Fixtures
SIGNATURE OF APPLICATION OWNER OR R AGENT 1(.-71-761 DATE JOB ADDRESS: SEQ. *: DATE: PROJ*: MA5G0 0 (0.*5 OWNER: 12.00. • " ADDRESS: CITSTA ZIP: 5 1 l tc 0 uJ 2 APPLICANT: CONTRACTOR: m 6-►MJ rc.M -, r►is . ADDRESS: 3W3 - r CITY: ST: ZIP: �Pof WA - agif& PH: LICENSE*: 92,4 — ARCH/ENGINEER: ADDRESS: CITY: ST: ZIP: PARCEL*: CENSUS TR: INSPECTOR: PLAT*: LOT&BLOCK FINAL PLAT NAME: ZONE*: ZONE FSB S-I 5-2 RSB MOD USE OF PERMIT: Ci )C FEES: A 0 PAID BY: CA CK CG NC JOB ADDRESS: COUNTER APP: Atr. PLANS EXAM: DAT I- ktT . 2 _ w -C . 2 - - 1 - sem . - eve - (A) N - } a O U W U LL LL 0 ; ' 05 -08 -84 406115 * 4610.06