1992, 10-15 Permit App: 92008963 ReroofPARCEL NUMBER:
INFORMATION WORKSHEET ne-E5c1c1
;3oo I eLog JP 00 N4eici
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STREET ADDRESS:
CITY/STATE/ZIP:
20s
SUBDIVISIO2j: ----- -
BLOCK:-; LOT: - ZONE: - -'DISTRICT:
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LOT AREA:F/A: WIDTH:- DEPTH: - R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER • DISTRICT: -
OWNER: 694-iJ4-- PHONE: ..222-_ -_4
% i 40,
MAILING ADDRESS:. / u0 ��
CITY/STATE/ZIP:
CONTACT:
afa
.GSC 99D3�
PHONE:- -
SETBACKS: - FRONT:' -..-, LEFT: RIGHT: REAR:
PERMIT USE:
/tai 99;2, .
- _:BIIILDING INFORMATION
CONTRACTOR LICENSE NUMBER: /qg- s;- •372/UT
CONTRACTOR:cS___. -.
afi - PHONE:
MAILING ADDRESS: (1 o 6 - •
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:,
MIN
NEW: REMODEL:' ADDITION: CHANGE OF USE:
DWELL UNITE: OCCUPANT LOAD: BIIILDING HGT: STORIES:' '
BIIILDING DIMENSIONS: = (WIDTH % DEPTH) SQ. FT.:
REQUIRED,PARKING: '"'#}HANDICAP:. SEWER (Y/N): HYDRANT:
a -e. _ Wit• }�. �,:wxx,.�J=s-t.: _i R�; e'd: r•va+o.
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I certify that the installations listed above have all been
completed satisfactorily in accordance with the speci
fications furnished me.
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SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
OK 'TO PAY•PAYING UNIT NO. 9( i7
TOTAL
AMOUNT
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CONTRACTOR
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ACCOUNT
NUMBER
ALLOCATION OF EXPENSE - FOR INSTALLATION OFFICE USE
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ADJUSTMENT
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