1986, 11-06 Permit 00013891 InspectSIGNATURE OF
OWNER OR AGENT
JOB ADDRESS
SED. �:
APPLICATION
DATE
DATE:
PR
FEES: PAID BY: CA I CK CG NC
COUNTER APP: PLAN5 EXAM: DATE:
? Ser a A l
it her 1 Width 14 f..en9Th 170 }'eight 10
,.sc. Desk. s Sl.JR{..f'9Af;`tGE
INSPECTOR'S rOPY
TOTni... FE
m i s c: F a e
11
OWNER:
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
FSB
S-1
S - Z'
RSB
MOD
USE OF PERMIT:
JOB ADDRESS:
(( 1
C R
SED. �:
APPLICATION
DATE
DATE:
PR
FEES: PAID BY: CA I CK CG NC
COUNTER APP: PLAN5 EXAM: DATE:
? Ser a A l
it her 1 Width 14 f..en9Th 170 }'eight 10
,.sc. Desk. s Sl.JR{..f'9Af;`tGE
INSPECTOR'S rOPY
TOTni... FE
m i s c: F a e
11