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1986, 06-04 Permit 00010720 Inspect
SIGNATURE OF OWNER OR AGENT. APPLICATION DATE JOB ADDRESS OWNER: ADDRESS: CITY: ST: ZIP: APPLICANT: CONTRACTOR: ADDRESS: RD CITY: ST: ZIP: Pm: LICENSE.: '-x1901e..)7 ARCH/ENGINEER: ADDRESS: CITY: ST: ZIP: PARCEL.: 'CENSUS TR: I INSPECTOR: PLAT.: LOT e< CLOCK FINAL PLAT NAME: .. . ZONE.: ONE F50 S I 5 2 RSD MOD AU. USE OF PERMIT: JOB ADDRESs: AL Lde Fee STRUCTURAL PROJECT, SEC, it: DATE: FEES: PAID DY: COUNTER PLANS CXAM: DATE: TOTAL. FEF TOTAL FEE Permit Fee 207A0 INSPECTOR'S COPY INSP-ID le DATE t_cfR,b 1 j _