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