1986, 12-17 Permit 00013883 Inspect!NSF -FL)
IV
DATE
1Z
-
-( -
'5
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS PROJECT
•
OWNCR.
ADDRESS:
CITY. ST: Zip:
APPLICANT:
CONTRACTOR:
. _
ADDRESS:
CITY: ST: ZIP:
PH: LICCNSE:e:
ARCH/ENGINECR:
ADDRESS:
CITY. ST: ZIP:
PARCCLar:
CENSUS TR:
INSPECTOR:
PLAT.,
LOT & BLOCK
FINAL
PLAT NAME.
ZONEs.
ZONE
rsa
s - s
s -
RSB
MOD
USE OF PERMiT:
JOB ADDRESS:
SEO.
DATE:
Fees:
PAIO
DT:
COUNTER API.:
PLANS CXAM:
DATE:
hECHANICAL PFRMIT
• • t 4 C 6 ... T OT L '
APPL Dr- 01 Gas Lod 0 Gas W/H u So lid Fos'
GAS P IP Quantity 01
FUEL SOUkG;i ; ic N Gas Oi 1 N Coa 1 N Woc:
INSPECTOR'S COPY