1985, 12-03 Permit App: 00008983 Repair Fire Damage(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
II Project Number
Owner's Name LAST FIRST MI
Project Address (Str Name & Number) Zip
/41171— 42;4 re/
Applicant
Address
City
State
Zip
Phone
Business Phone
( )
Contractor/Agent/
Address
CasesState
- - i
p
- -2-07U/
Phone
.y
( ) 4/��' 6 y/7�
Contact
License Number (Required)
"4t'H C '4
7/A•9
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
Describe Work ' /�. �//J
f.....;1
Res.
Comm,
Subdivision/Plat Nam Short Plat Number „i(
!/
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Lett Setback
Right Setback
Rear Setback
R/W Width
Additional Information
BUILDING INFORMATION
Square Footage
14.'3 i r' C J
Number of Bedrooms
BUIItlI�echnje ^'�
en /l C4!)l{
Date
Group
,ii -3
Type
;TN)