Loading...
1992, 05-05 Permit App: 92003101 ReroofPARCEL NUMBER: - 3/0/ a3a414, INFORMATION WORKSHEET STREET ADDRESS: `21 /L/oZ L ) 7 �C - • CITY/STATE/ZIP: ,j/QC- / ' Cect- SUBDIVISION: BLOCK:. .: .: LOT: ZONE: DISTRICT: LOT AREA:- P/A: WIDTH:- DEPTH: R/W: OF BUILDINGS:_ . # OF DWELLINGS: .WATER -DISTRICT: OWNER: (uJ ". ... ( PHONE : 569 9 9 [ / / / 9 14? ILING ADDRESS': l / y CITY/STATE/ZIP : 4.0-k_O--"L_P I a 9a_ q c�-- f 0_ CONTACT: - PHONE:- - .- - SETBACKS: - FRONT: -. . LEFT : / /RIGHT : . --REAR: ,/ PERMIT USE: �- /2 5- <� .6.. k1:? -r) J S(a) *************************s***********************,talc************************* .BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: \A9A,%,_,1_. //06 PHONE: - - CG/ /7 MAILING ADDRESS: Pc.6 . 3 1 Q `% jQ--/L 4-(.)P , (-CC's ggag ARCHITECT/ENGINEER: PHONE : , - MAILING ADDRESS: NEW: REMODEL: / ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: REQUIRED PARKING: 1 (WIDTH X DEPTH) SQ. FT.: # HANDICAP: SEWER (Y/N): HYDRANT: PAY T atie"d 47JVIOJE RECAP AND DISBURSEMENT VOUCHER CUSTOMER'S NAME 19 z /ece„ SALESCHECK NUMBER STORE NO. (/079 STORE A4 kaite_., JOB I.D. NO. OR WORK ORDER NO. I cer P t tstallations listed above have all been completed satisfactorily in accordance with the speci fications furnished me. (CONTRACTOR'S SIGNATURE) TOTAL AMOUNT AMOUNT DUE CONTRACTOR WeJel DATE No. 463380 ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE USE ACCOUNT NUMBER DIV. NO. ADJUSTMENT ACCT. ACCT. CONTRACTOR EXPENSE MEMO SELLING 4 TOTALS OK TO PAY (AUTHORIZED SIGNATURE) CHECK NO. 14489 ISaa Rill 0-1R7 Part II Sunn. RI RFV 3/91 SFARS FORMS MANA(;FMFNT PAYING UNIT NO. PAYING UNIT NAME (If Different)