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1986, 01-23 Permit 00009453 NotesSIGNATURE OF APPLICATION OWNER OR AGENT DATE JOD ADDRESS: OWNCR: ADDRESS: CITY: 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 FS0 5-1 S - 2 RSD MOD USE OW PERNIrT: JOB ADDRESS: SEQ. rt/r: DATE: PROJN: FEES: PAID OY: CA OK CG NC COUNTER APP: PLANS EXAM: DATE• • • o o m 0 0 0 ; 1::: J.) 1:5 I • 1.) N c'D t -4/ /' At/ \-4 (./" .2-/Y‘ • ) / T c..:-,•••• • � INSPECTOR'S COPY