1986, 09-24 Permit App: 00013280 Carport Roof(ZHIST%NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
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Project Number
Owner's Name LAST FIRST MI
Ari 11/ OW Z Ail ahe._,
Pr eject Address (Street Name & Number) Zip ��/�
L-- /tea /9 UeSme '?
Applicant
a/ //7/p-72/ Wa /11a r -i e,
Address
130/9 01)._ 5
City
1 \a. V 1
State I!Y A-
I/
ZIp9 i?/
Phone
JJ Oq ( ) / c5 / - g9 3 /
Business Phone
( )
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect /Engineer
Address
City
State
Zip
Phone
1 1
Contact
Business Phone
( 1
Lender
Address
City
State I Lip
1
Phone
(
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es
Comm.
on PlatN@Fnel,St orttrPlat Number
OcTetm
AseeeecrParcel Number
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Lot
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Block)Plat
Number
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Zone
Comp. Plan
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Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
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Lett Setback
Right Setback
Rear Setback
RI W Width
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IBUILDING INFORMATION I
Square Footage
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Number of Bedrooms
noTechn
Date
Group
Type
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