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1986, 05-12 Permit App: 00010970 Demolition
(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT 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 DEPARTMENTAL USE Project Number 'O�7D Owner's Name LAST FIRST MI DAA) 1+U itiTtk Project Address (Street Name & Number) Zip E 56)Q i 300P LI Applicant y� �At?Se) ft3 S jrtc,I(fi/OL. Address C'S C)S ` 5 ` City (,ODk"G;. - State ( -..,,) Zip 9 C/[[ /2 Phone (5-7 -5 )" 7c/tl Business Phone ( ) flrnt✓.. Contractor/Agent e- C1(� vert S (I rn ,_^7,., l i 7 i 0n-.. 1 rti c_ Address A. C, Scp 5 7 City J( ;I cl,..--- State iv Zip 72J2 Phone (53S) --r)c) I4/ Contact License Number (Required) Lfl1 Sc) Di r(ot' -I? U Business Phone ( ) 50m- Architect/Engineers ),�.y//�� Wire Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone ( ) s - <;.�.':• Res. Comm. r•mber k. `411 f '``� W 2© C"s l Number'»b::,,j :3.:.., '«..,:, Lot Block Plat Number Nu` ter ;•' Zone Comp. Plan Census Tract r .�XF•. 4 Number of•Bufdings _ ' ' :.� -• �>..� ' Lot Size (Sq. Ft. /Acre) Depth i3S'"- . Frontage y s tc.;x° r. "� Right Setback�.: Rau Setback �,' , .. .. ,SCS R/ W Width ^,i'l 4, {. yF� 1AI I/ '� kW^^I, xA tage •Ytb. rt' ,a'.a.a; ....'k :. '\✓. +cr. ..+Lid>+lr+ M�Mkas ".,, ;.1. Ar 0 kx' U 0 ,y Yom. .v x �✓ ...,`„�, , o.Bedrooms fpt' .,„. rrg..i;«... v .... 1Fj�A?F , • r.Y�” Type