1986, 11-13 Permit 00013460 InspectSIGNATURE OF APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS
OwNER:
ADDRESS:.
CITY: ST: ZIP:
APPLICANT:
.
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PM: LICENSE.,
ARCH/ENGINEER:
ADDRESS:
CITY ST: ZIP:
PARCEL.: 'CENSUS TR:
INSPECTOR:
PLAT.:
LOT & BLOCK
FINAL
PLAT NAME:
ZONE.:
ZONE
FSO
5-1
S - 2
RSa
MOD
USE OF PERMIT:
J00 ADDRESS:
V' h T
PROJEC*1
SEO.
DATE:
FEES:
PAID BY:
COUNTER APP:
PLANS EXAM:
DATE:
0.fAl.. FEE
6 nge Gas I...o g 0 Gas W/H 01 Solid Fuel 0 I=
TEM Qua n tit y
.-J): 100K or Less 01 Oyer 100K u F•
N Gas Y Oil N Coal 0 Wood N Sojar N
f.. Air Y Radiant N Heat Punp 0
Processinr:
INSPECTOR'S COPY