1984, 09-24 Permit App: 00002478 Soffit, Fasciaf
CD 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 (last) (first) (m)
Department Use Only
,l e 5 A-11 L__ .
�. Comm
2 Project Address (not Mailing Address) or d Name Space Zip
5 , /) 714 M a urt.GL - Alf9"a• 9%zo6
3 City/Comm/unity n .� a
7K'
State \
w il
Subdivision/Plat Name
4 Pssess6r Parce o
I(tii� F{7 /t �/)
l N(V
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.. a
Zone
Project No.
6 Dwell N
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front I (L)S-1
(R)5-2 I Rear
Census Tract
Module No.
Initials
16 Architect Firm Name ( Street Address
Zip
City
State
Phone
( )
Contact Person
Phone it different than above
Contractor Firm Name
P�I�/'/,�� �tolltie r5 conte th rs h
Street Address
_ Ai 3/06 A on/Le- god .
IZip 7"
gQa.l r2
City
SE-okc -e___
State
60A•
Phone
(ai9) 9.z8 -5L686
b CkiltectPerson
f tart Mr(/(u1
License No.
Mc - VA --y 6 -(34&m6
Phone If different than above
( ) .5Q m2—_
8 Owner/Agent if different than #1 aabove)
Busi ess Address
9 Zip
City -
State
Phone
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA Exempt (YIN)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
% 01h9q. •
F-€..
14 Describe Wor H -t c1
10 Applicant Name
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone if different than above
( )
Additional Information
VO 04 ti2 fz an — -1440
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