1992, 10-15 Permit App: 92008965 ReroofPARCEL NUMBER:
STREET ADDRESS: 1.. _ /sem T3
INFORMATION WORKSHEET O-(-)
2S,/-11 1 /
°V111 -I R 91'3s
CITY/STATE/ZIP:
SUBDIVISIO2f:
:BLOCX:- LOT: ZONE: DISTRICT:
LOT AREA:-. F/A: WIDTE:• DEPTH: R/W:
e• y,f,
# OF.BUILDINGS:-
OWNER. .C� 44-/-/t/
.MAILING ADDRESS:
CITY/STATE/ZIP:
. # OF DWELLINGS:. .WATER•DISTRICT:
CONTACT:
PHONE: _.L- 6
zL2 42'q3e);
PHONE: -
SETBACKS: - FRONT: LEFT: RIGHT: -LtEAR:
PERMIT USE: i .
/4h_ewileig-2-7 —
***************************************+************************************
.BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
alA.O/A0
MAILING ADDRESS:
PHONE: c-
ARCHITECT/ENGINEER:
MAILING ADDRESS:
NEW: REMODEL: li ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
PHONE:'
BUILDING DIMENSIONS: S (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING:
# HANDICAP: SEWER (Y/N): HYDRANT:
PAY TO
VOICE RECAP AND DISBURSEMENT VOUCHER
STORE NO.
STORE
No. 742354
(CONTRACTOR'S SIGNATURE)
CHECK NO.
14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
(DATE)
ACCOUNTING COPY
PAYING
UNIT NAME
(/1 Different)
DATE —,.54;t9.._
CUSTOMER'S NAME
SALESCHECK
JOB I.D. NO. OR
MOUIN
DUE
",,,
ALLOCATION OF EXPENSE - FOR INSTALLATION OFFICE USE l'
NUMBER
WORK ORDER NO,
CONTRACTOR
ACCOUNT
NUMBER
DIV.
NO.
ADJUSTMENT
ACCT.
CONTRACTOR
MEMO
ACCT
EXPENSE
SELLING
/0
Nj4429.46,6&.- 4 ''.- / -....
g GRD vsy-
2i
-4
dg'c3
—2 -f -a-
/ ,
- -
!I
r --
c rti y t a e installations listed have
above all been
completed satisfactorily in accordance with the speci
fications furnished me.
TOTAL
AMOUNT
47'
TOTALS
4,
OK TO PAY
PAYING
(AUTHORIZED SIGNATURF UNIT NO.
(CONTRACTOR'S SIGNATURE)
CHECK NO.
14489 (See Bul. 0-187 Part 11 Supp. 8) REV. 3/91 SEARS FORMS MANAGEMENT
(DATE)
ACCOUNTING COPY
PAYING
UNIT NAME
(/1 Different)