1986, 08-11 Permit App: 00012487 Reroof(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)
--_- -----...._. _...__..,.... ...—...,.-...,._
Project Number �2�-8 J
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Owner's Name LAST FIRST MI `
Project Address (treet Name & Number) Zip
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A. plicant% Address
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City
S ate Zip
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6
Phone 7
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Business Phone
Contract. I Agen t
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Address
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State
Zip
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Co
L ense Numb (Required)
Business Phone
Architect/ tngineer
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Address
City
State
Zip
Phone
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Contact
Business Phone
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Lender
Address
City
State
Zip
Phone
( 1
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Res
Comm.
fP Plat Number
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Lot
Block
Plat Number
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Zone
12- Z
Comp. Plan
Census tract
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Number of Buildings
Lot Size (Sq. Ft./Acre )
ioCc0
Depth P
Frontage
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Right Setback
RearSetbacic..
R/WWidth
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Squat's Footage..
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m
Number of Bedrooms
6 y
Group
Type