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1986, 10-21 Permit App: 00013757 Re-side
- • (THIS IS NOT A PERMIT) • , BUILDING PERMIT APPLICATION WORKSHEET PLEASE P;RINT?AND COMPLETE ONLY. THOSE PARTS OF THE FORM YOU UNDERSTAND • COMPLETE IN INK .• (Please return this original and your building plans to the Department of Building and Safety) - . - • - - . SHADED AREAS ARE FOR DEPAHINI tN I AL L.It • . , • . . , • I Project Number •. -- '41.5;k•-' ..,. Owner's Name . LAST • • FIRST Ml .... • ' 2 e-42.4140 P- i • . Project Address (Street Name & Number),Zip • it/ ) 0 Y e e .s.s 1 r • . • • Applicant Address City • Site • Zip. - Phone . .- . . . ' - • , • • • Business Phone - • . .. ( 1 . • Contractor/Agent i :• - •• 'Address . - / City --5,9 /ea- AI e State /...c.i,t, • Zip 9 2-e 7 Phone • (1.4523) ,s--/ ,s-7- A, . Con,t. a.._;.....k.. •in..-Ptie..-19g4-0-"---- License Number Recuirerl) . ' e 15 e-- - 44,;c__- .z'' Business Phone "Y 3) .‘--- i 5-4 _ Architect i Engineer Address City • State rp Phone ( - Contact • Business Phone " . I ) Lender Address . ' . 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