1986, 03-21 Permit App: 00010140 Garage Addition(THIS IS NOTA PERMIT)
BUILDING PERMIT A-PDLICATION 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
Owner's Name
LAST
FIRST
MI
Project Address (Street Name & Number)
l l 2- la 6r._G (.r)
Zip
Applicant
City
d
Zip
Address
Contractor/Agent
City
State
Contact
Architect/Engineer
Phone
Business Phone
( )
Address
Zip
License Number (Required)
Phone
Business Phone
( )
Contact
Lender
City
Business Phone
Address
State
Zip
Phone