1987, 10-08 Permit App: 87003389 Reroof(Tits is NOTA PERMIT)
BUILDING PERMIT IS1PLICATION 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
L
AST
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FIRST
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MI
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dc.rl cf Stene.
Business Phare
( I( ) •
Zip
83g/q
State
Business Phone
Address
Zip