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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