1992, 06-11 Permit App: 92004258 ReroofPARCEL NUMBER:
INFORMATION WORXSHEE
aLk(Q0
-
STREET ADDRESS:
CITY/STATE/ZIP:
SUBDIVISION:
II ( Itere;,-71
BLOCK:. • LOT:
ZONE:
LOT AREA:'. _ . :F/A: WIDTH:_
# OF BUILDINGS:.
OWNER: (1) t (�� 4,r1
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT:
# OF DWELLINGS:
//6-hC� 3—i1
DISTRICT:
DEPTH:
R/W:
.WATER'DISTRICT:
PHONE:
J2.1„ (p)o.
PHONE: -
SETBACKS: — FRONT: LEFT:
PERMIT USE: Q , A z (
RIGHT: ~ • REAR:
(Jai/.tii� /q'7
*************Mfr*******************eft****************4e*************************
.BUILDING INFORMATION
LICENSE NUMBER: 5 F Si - % N 7
1�
CONTRACTOR
CONTRACTOR:
MAILING ADDRESS : r ' c ` -c-) 0-7 4
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE : �j7(( -(18(1 - I /7
-10-)4LW ( (,eJ
PHONE : ' - •
NEW: REMODEL: ✓ ADDITION:
DWELL UNITS: OCCUPANT LOAD:
BUILDING DIMENSIONS:
REQUIRED PARKING:
S
# HANDICAP:
CHANGE OF USE:
BUILDING HGT:
STORIES:
(WIDTH X DEPTH) SQ. FT.:
SEWER (Y/N):
HYDRANT:
PAY TO
VOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO 7
9/79
STORE p-1
No. 780863
DATE U/ 90—
AMOUNT
-
I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
(CONTRACTOR'S SIGNATURE)
TOTAL
AMOUNT
5/7
OK TO PAY
TOTALS
(AUTHORIZED SIGNATURE)
CHECK NO.
14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY
PAYING UNIT NO.
77
PAYING
UNIT NAME
(if Different)
CUSTOMER'S NAME
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
MOUNT
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE
DUE
CONTRACTOR
ACCOUNT
NUMBER
DIV.
NO.
ADJUSTMENT
ACCT.
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
l� Pim5
y4. -a/
,57
/M
397
57
96 422
/l9a a fe
i, .
A
t
I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
(CONTRACTOR'S SIGNATURE)
TOTAL
AMOUNT
5/7
OK TO PAY
TOTALS
(AUTHORIZED SIGNATURE)
CHECK NO.
14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
ACCOUNTING COPY
PAYING UNIT NO.
77
PAYING
UNIT NAME
(if Different)