1985, 07-23 Permit App: 00006492 Siding, Soffit, Fascia*
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (first) .. (m (last) )
Department Useiaiily
I /
/r��i�a0 Iarn C) / 1
Fes. •/ Comm
2 Project Address not Mailing Address) a Road me ���....JJJ Space Zip
- //(91 C.1 47/0 Y�,fJ P 942 (
3 City/mmunity�
/��0t i
State //�
'a (J
Subdivision// lat Name
T'f 4-RrO#J
4 r Parcel No.
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/'-,� /%/l�/� l n
Lot L
BI * * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. p
ZonePn Project No. ��
!� L
6 Dwell ft
No. of Buildings
Sq. Ft./Acre
I/C
Depth
Frontage
7 Set Back -Front I (L)S-1
(R)S-2 `I I Rear
nous Tract
Module No.
Initials
r 16 Architect Firm Name Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
( 1
Contractor Firm Name //
s
Street Address 6 -7(7/1
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Zipill
City
a
1 q9_-/* .i --F6-(9_0,,,_
State
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Phone �/y( 0 . (,�
(SO ) 97-7 6 76
i Contact Person
F 7 (i f/1rr i�/1- Va Cif -
ense No.
i714(744V4 3l SClo1f%-
i
Phone If different than above
( ) �in/W Li
8 Owner/Agent (if different than #1 abece)
Busi ass Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (YIN) ISEPA Exempt (YI N)
Date
15 Type Work 0 Bldg
❑ Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
(<" Other
Mpg/ ✓
14 Describe Work
S ar SII/ t � �-
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
Additional Information
fiA /a 1 4 7, 00