1986, 10-27 Permit 00013369 InspectINSP-ID
DATE
0-27-
/6/30
'
-/ '
...
"
3 c-
57a
0 ( s
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
JOB ADDRESS PROJEC, ,r
OWNER:
ADDRESS:
CITY: ST: SIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PM: LICENSE a:
ARCM/ENGINEER:
ADDRESS:
CITY: ST: ZIP:
PARCEL.: ICEN5U5 TR:
INSPECTOR:
PLAT.:
LOT 8c BLOCK
FINAL
PLAT NAME:
ZONE.:
ZONE
F50
S-I
S - 2
R5B
MOO
USE OF PERMIT:
JOB ADDRESS:
hF 1.'.H{-iI1AL,1- f...
SEG. f:
DATE:
FEES:
PAID BY:
6
COUNTER APP:
PLANS EXAM:
DATE:
r. L
u Range Q Gas Loa U Gas W/H U Solid Fuel
SOURCE; 1: lec tri.c: N Gas N 0 .1. N Coal 0 Wood Y Soar
alr
I:i LITa iN: 1=o,..c:ec Air N Y Heat rump 0
fo
INSPECTOR'S COPY