1986, 05-30 Permit App: 00011302 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)
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Project Number 697
Owner's jNameLAST F RST Ml
Le edigt. , % er�r1-/tl 4- ��4-C k 7-160 J
Project Address (Street Name & Number) Zip
/%/ s3 01/ Cr i7 ,S
Appliccany �
�D F` - /sl��s ( C� �jrtJ.S%4r c i c14..../.40) 14`/.p,Z j
Address
5-6 o i %-1.4-,^4
City%%
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State
Zip
Phone
) gv ryki _ ���
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ef•- ° 7
Business Phone
Contractor /AgentAddress
5 -7.1 -A
-c -e
City
State
Zip
Phone
( )
Contact
License Number (Required)
Vo i E. C ZOO 140
Business Phone
( )
Architect /Engineer
Address
City
State I Zip
Phone
( )
—L
Contact
Business Phone
( )
Lender
Address
City
State I Zip
t
Phone
( )
DescribeWork
Res.
_
Comm.
S diiviis /Plat Name/Short Plat Number
I AkniAGE 12649A -taw Ekt e.,s
Assessor Parcel Number Lot
aq 51z -0-7&2- 1
Block
Plat Number
Pertinent File Numbers Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
J Lot Size (Sq. Ft. /Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/ W Width
Additional Information
MINPirlag _ t 10 000.°
BUILDING INFORMATION
Square Footage
�< a
Number of Bedrooms
ding Technician
Date
Group
Type