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1985, 11-26 Permit App: 00008919 Repair(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) vi li-i nn.n rvn vrnn I rvi =PI I /AL vac II Project Number ( l I 691/ 1 Owner's Name j� LAST JJ�� FIRST MI' / 0If is P.e ri ni5 Project Address (Street Name & Number)Zip E9 2 2? /—wr- r- Air )"G..1( c., Applicant Address City State Zip Phone Business Phone ( ) Contractor/Agent / LeINIKcr1 Cr ` r�s7-rac4•r`s,^ Cc. Add ess / ?74%2/ 6t /0 71,-4— City State Zip Phone 9 2 '_ U C c 2 Contact tY��] Lf / (�or ILI M License Number (Required) Lr�`GN GCC ,ss SG Business Phone ( I Sfy,,-.. Architect/Engineer 3 % j0/8 Ca / 1 0/8Ca Address City State Phone Contact Business Phone ( 1 Lender Address City State Zip Phone ( ) Describe Workn itt✓V 9kae-NILE Res. Comm. Subdivision/Plat Name/Short Plat Number 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 Left Setback Right Setback Rear Setback R/W Width Additional Information t/ cit.otJ = 32, 0 °' IBUILDING INFORMATION Square Footage Number of Bedrooms Building Technician Date Group Type