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PARCEL NUMB
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STREET ADDRESS:T
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'CITY/STATE/ZIP: , > Pi-)tAncc u3P, 6 O-Oln z
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SUBDIVISION:
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BLOCK: LOT: ZONE: DISTRICT: r
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%.LOT_AREA: F/A: WIDTH: DEPTH: R/W: *
@-OF;BUILDINGS: if OF DWELLINGS: ; WATER DISTRICT: *
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MAILING ADDRESS: ) k („02 'A t_ i1AN r
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CITY/STATE/ZIP: Sfnrocr`'Z ' L--)A_I$ Ce x
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CONTACT: >��Z PHONE: Sb1 - 1 16 - '-1( 6( x
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SETBACKS: - FRONT: LEFT: RIGHT: REAR: *
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: t1C UR eNc 3 y G, hal
CONTRACTOR: `}-'j° UA`l P)2011h /2'S PHONE: SJ`\ - A 3 - 4c, 3b
'MAILING ADDRESS: n 3 nu
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ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS;
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
(WIDTH X DEPTH) SQ. FT.:
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BUILDING DIMENSIONS: X
REQUIRED PARKING: 11 HANDICAP:
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SEWER (Y/N): HYDRANT:
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