1986, 11-12 Permit App: 00014082 Remodel'7 qj� (THIS IS NOT A 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
Project Number � —�
Owner's Name LAST FIR/ST MI
�7-
..l Uhl
Project Address (Street Name & Number)
Zip
91 Z,
ess
Applicant:�� r,e
e. S CA USl - 3
fsc / c9
City State Zip Phone
Business Phone
ty��) sus
Contractor/ Agent Address
'67 5 Z a �e
.csTy
City State. Zip Phone
CA--' A.-,' L03
Sys ,G
Contact License Number (Required) Business Phone
we -.2,0 6 J (yy3) S
Architect/ Engineer Address
City
FState—,
Zip
Phone
l )
Contact
Business Phone
Lender
Address
City State Zip Phone
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W.7.1
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