1986, 09-01 Permit 00010211 InspectINSP-ID
DATE
O
m
J
d
Im
Z
y
SIGNATURE OF
APPLICATION
OWNER OR AGENT,. DATE
JOB ADDRESS
OWNER:
CITY: 5T: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PH:
LICENSE*:
ARCH/ENGINEER:
ADDRESS:
clrv: sr: ZIP:
PARCEL*:
CENSUS TR:
INSPECTOR:
PLAT*:
LOT & BLOCI(
FINAL
PLAT NAME:
ZONE*:
ZONE
F5B
S-1
S 2
RSB
MOD
USE OF PERMIT:
JOB ADDRESS:
SEG. *:
DATE:
PROJEC•
FEES:
PAID BY:
G
COUNTER APP:
PLANS EXAM:
DATE:
•
INCP 1'Tno'e nnov