1986, 10-06 Permit App: 00013452 Bathroom Remodel(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 ARF FOR nFPARTMFNTAI I ICG
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Owner's Name LAST
FIRST M I
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Project Address (Street Name & Number)
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Zip
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Applicant
Address
City
State
Zip
. Phone
Business Phone
Contractor/Agent
Address
CitySt
ate
Zip
Phone
Contact
License Number (Required)
Business Phone
Architect/ Engineer
Address
City
state
Zip
Phone
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Contact
Business Phone
Lender
Address
City State
Zip Phone
Block � � � Plat Number r : ,
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Zone to Plani
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Num of ihling tJnrts Number of Bwtdings -
Lot Size (Sq Ft (Acre) Oepth Frontage
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