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1986, 02-13 Permit 00009585 Inspect
SIGNATURE OF OWNER OR AGENT APPLICATION DATE OWNER: ADDRESS: CITY: ST: ZIP: APPLICANT: CONTRACTOR: ADDRESS: CITY: Sr: ZIP: PH: LICENSEa: ARCH/ENGINEER: ADDRESS: CITY: 5T: ZIP: PARCEL=: !CENSUS TR: INSPECTOR: PLATS: LOT & BLOCK FINAL PLAT NAME: IZONE=: ` ONE I FSB S-I S - 2 R50 MOD USE OF PERMIT: JOB ADDRESS: PROJECT# SEO. a. DATE: FEES: PAID BY: COUNTER API: PLANS EXAM: DATE: INSPECTOR'S COPY