1986, 08-08 Permit 00012542 InspectINSP-ID
DATE
I
it
IE OF
3 AGENT_
APPLI( ION
DATE
JOB ADDRESS
OWNER:
ADDRESS:
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PM: LICENSE*:
ARCM/ENGINEE•R:
ADDRESS:
CITY: ST: ZIP:
PARCELS:
CENSUS TR:
INSPECTOR:
PLAT*:
LOT $C BLOCK
FINAL
PLAT NAME:
ZONE*:
ZONE
P5O
5-1
5-2
R55
MOD
USE OF PERMIT:
JO0 ADDRESS:
PROJEC'1
FEES:
COUNTER APP:
PAID BY:
PLANS EXAM:
CK
G
NC
DATE:
INSPECTOR'S COPY