1987, 02-02 Permit 00014045 InspectINSP-ID irsa
DATE .✓.
r i- -- i
304.
7
SISNATURE OF APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS
OWNER:
ACORC55:
CITY: 5T: ZIP:
APPLICANT:
CONTRACTOR:
AC DRESS:
CITY: 5T: ZIP:
PH: LICENSES:
ARCH/ENGINEER:
ACDR E55:
CITY: 5T: ZIP:
PARCELS: ((CENSUS TR:
INSPECTOR:
PL>T=:
LOT & BLOCK
FINAL
PLOT NAME:
ZONE=:
ZONE
PS0
S 1
5-2
R5B
MOD
USE OF PERMIT:
JO3 ADDRESS:
f-1 V
riECIAANICAL. PERMIT
EC.::. IN F
PROJEC
FEES:
COUNTER APP:
PAID DY:
PLANS EXAM:
TO T E::
G; N Q i :I. N Goo :1. NI. wood N ci J 4 r N
DATE:
INSPECTOR'S COPY