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1991, 03-27 Permit App: 91001415 ReroofPARCEL NUMBER: -ft INFORMATION WORKSHEET • STREET ADDRESS: 31/(1 /64,,,Y),4 CITY/STATE/ZIP: 11/4'11 SUBDIVISION: Z()q, 9 e .>-/& BLOCK: LOT: ZONE: LOT AREA: F/A: # OF BUILDINGS:- . # OWNER: WIDTH: OF DWELLINGS: /4 Pa Q MAILING ADDRESS: CITY/STATE/ZIP: CONTACT: 7 x44 -.1. - DISTRICT: DEPTH: R/W: WATER DISTRICT: PHONE: ,529__- icay' - -73 awn & of 9a,- Q9agn PHorrE: 619-.7 - /%%f) Y3V94 SETBACKS: - FRONT: PERMIT USE: LEFT: RIGHT: REAR: BUILDING INFORMATION CONTRACTOR LICENSE NtJHBER: SE - fI-,e —S -,Q - 5 7 k) T CONTRACTOR: Xlp()40i/ 4(14-912—, PHONE: Scop -4igei -1190A/9(6i p© 6 3 7 07 MAILING ADDRESS: ARCHITECT/ENGINEER: MAILING ADDRESS: PHONE:, NEW: REMODEL: X ADDITION: DWELL UNITS: OCCUPANT LOAD: BUILDING DIMENSIONS: REQUIRED PARKING: o7/ftt)-6iceJ 3LIAC # HANDICAP: CHANGE OF USE: BUILDING HGT: STORIES: (WIDTH X DEPTH) SQ. FT.: SEWER (Y/N): HYDRANT: 07 O co a(llVNDIS S.HO10VH±N00) m z p Av. c CD D m m I certify that the. installations listed above have all been completed. satisfactohlysinraccordance with the .specifications furnished me.• i • • • J r, `` \ t t1 CUSTOMER'S NAME 00 SALESCHECK NUMBER , t JOB I.D. NO. OR • WORK ORDER NO. j r 1OK TO PAY 'Ii -•( + ' TOTAL AMOUNT V AMOUNT DUE , CONTRACTOR • ACCOUNT NUMBER ALLOCATION OF EXPENSE - FOR INSTALLATION OFFICE USE . 0< ADJUSTMENT ' PAYING UNIT NO 0 , -1 CONTRACTOR' EXPENSE MEMO SELLING 18 1 BY