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INFORMATION WORKSHEET
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PARCEL NUMBER:
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STREET ADDRESS: l"L (\ q C-- C -12, -so ---,4-0 *
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CITY/STATE/ZIP: SpO\C.A..,c wn (:\ 4212_04,. *
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SUBDIVISION: *
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BLOCK: LOT: ZONE: DISTRICT: *
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LOT AREA: F/A: WIDTH: DEPTH: R/W: *
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# OF BUILDINGS: # OF DWELLINGS: , WATER DISTRICT: *
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OWNER: C -p S f rcc--( PHONE: -A-7V -'l7 (,Z-- *
MAILING ADDRESS: \--1-klai CAA Y`e l ( *
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CITY/STATE/ZIP: S P o lay.-{ \AM 9 gZ6 *
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CONTACT: PHONE: - - *
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SETBACKS: - FRONT: LEFT: RIGHT: REAR: *
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PERMIT USE: Sta;.ti5 (Setc: is /�asC,A *
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BUILDING INFORMATION *
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CONTRACTOR LICENSE NUMBER: Ch<_vny(3C3L(lr,Ple *
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CONTRACTOR: \V"\C \iA`( Rr&S. ,,/PHONE: -5Z8 -4L *
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MAILING ADDRESS: N- 31OZo (NA,cc0^',e �a,'. S.TQ Z--) I\ 9atz-(Z *
ARCHITECT/ENGINEER: N hk PHONE: - - *
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MAILING ADDRESS: *
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NEW: REMODEL: ADDITION: CHANGE OF USE: *
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DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: *
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BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.: *
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REQUIRED PARKING: 4 (HANDICAP: SEWER (Y/N): HYDRANT: *
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