Loading...
1992, 07-23 Permit App: 92006187 ReroofPARCEL NWCER: STREET ADDRESS: CITY/STATE/ZIP: INFORMATION WORKSHEET Qa-(o1r( (ckaao SUBDIVISION: ,drf_ ( 7)0. 99 ,Q(p BLOCS: LOT AREA: - IAT: # OF BUILDINGS:_ ZONE: - DISTRICT: WIDTH:- DEPTH: R/W: # OF DWELLINGS: WATER • DISTRICT: OWNER: 7 / 12_,:a0.14Lf PEONE: ,09 - 9- 4:395.- '.` 9. /> . X MAT• ITNG ADDRESS: �]- - �/ r/ CITY/STATE/ZIP: AQ_�1 i !lL (/ , �X Q 9 q,90 PHONE:- - CONTACT: SETBACKS: - FRONT: -. PERMIT USE: /j, LEFT: RIGHT: vaitkotie6--zi 3 cO- •BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: SE - /4/€ - 37.:2'U / CONTRACTOR: _45; &a.. /i(O q1,4 Q _Q MAILING ADDRESS: Po e3r)D PHONE: en- - 1 /_ vll/ ,Oa a -t4 o l,64-5WQ ARCHITECT/ENGINEER: .. MAILING ADDRESS: PHONE: NEW: REMODEL: k ADDITION: DWELL UNITS: OCCUPANT LOAD: BUILDING DIMENSIONS: REQUIRED PARKING: CHANGE OF USE: BUILDING MGT: STORIES: % (WIDTH % DEPTH) SQ. FT.: $ HANDICAP: SEWER (Y/N): HYDRANT: PAY TOSi • �) INVOICE RECAP AND DISBURSEMENT VOUCHER STORE NO. pin 77 STORE \ J p _k _/.Lc_ No. 773217 �/ DATE — .9-3-93 CUSTOMER'S NAME -SALESCRECK + NUMBER '' JOB ID. NO. OR WORK ORDER NO. AMOUNT DUE ' CONTRACTOR ALLOCATION OF EXPENSE— FOR INSTALLATION OFFICE USE ACCOUNT NUMBER DIV ' NO. ADJUSTMENT ACCT. ACCT. CONTRACTOR EXPENSE - MEMO SELLING 7rlah&rtc 4crhAra. _ 7-,-3 Eaa3si1 7g -SI molt c 788y '9/ITh GTM- a Rv iI.*.... _. • . Li+ -1 '. I certify that the -installations listed above have all been completed satisfactorily in accordance with the speci ficatioris furnished me. (CONTRACTOR'S SIGNATURE) TOTAL AMOUNT OK TO PAY TOTALS (AUTHORIZED SIGNATURE) CHECK NO 14489 (See Bul. 0-187 Part 11 Supp. 8) REV 3/91 SEARS FORMS MANAGEMENT (DATE) ACCOUNTING COPY PAYING UNIT NO q 79 -4 PAYING UNIT NAME (l! Different)