1992, 09-11 Permit App: 92007511 Reroofq 151(
1 G��� 3� v ZNFORHATION W)RRSHEET
PARCEL NUMBER:
STREET ADDRESS:
g703 b'i ca41))-, c
CITY/STATE/ZIP:_
SUBDIVISION.
BLOCK:
LOT AREA:
# OF BUILDINGS:
OWNER:
da a")2.1 -y 7J)a 1111
IAT:
ZONE: - DISTRICT:
F/A: WIDTH: DEPTH: R/W:
# OF DWELLINGS: WATER DISTRICT:
MAILING ADDRESS: r703 -
PHONE: 5:(-2C22:" /5-7
CITY/STATE/ZIP: (i„n O / a 9z % Q /9 -
CONTACT:
SETBACKS: - FRONT:
PERMIT USE: /CX
- -
PHONE:- -
LEFT: RIGHT:-
_REAR:
Oaktet , as �,3
a***,tea*,a**********a,*********************a*********************a***********
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: S6 - A2 -Se- 3`7a /Ars6t_
D P PHONE: Nj?
CONTRACTOR: 00,10n /
MAILING ADDRESS: /9O 6 %0r7 k1faa nt �/ QQaQn
ARCHITECT/ENGINEER: - PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: % (WIDTH % DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SEWER (Y/N): HYDRANT:
PAY TO
" INVO CE RECAP AND DISBURSEMENT -VOUCHER
•
STORE NO (r7/0)79
STORE eliaz-fr[_e
No. 780422
DATE 0- 9—/"/c2--
CUSTOMER'S NAME
SALESCHECK
NUMBER
JOB I.D. NO. OR
WORK ORDER NO.
AMOUNT
DUE
CONTRACTOR
ALLOCATION OF EXPENSE — FOR INSTALLATION OFFICE -USE
ACCOUNT
NUMBER
DIV.
NO
ADJUSTMENT
ACCT. -
ACCT.
CONTRACTOR
EXPENSE
MEMO
SELLING
�,�t�o�.
p
7
epp9,1,•e/.
as/er
s __.
/rim
.
e9
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de`p G
Rita Z Mmeteri
AT
•
r
• ... ...._
r-
a ..
..
-
I certify that the Installations listed above have all been
completed satisfactorily in accordance with the speci
ficatlons furnished me. '
(CONTRACTOR'S SIGNATURE)
14489 (See Sul 0-187 Part II Supp 8) REV. 3/91 SEARS FORMS MANAGEMENT,
TOTAL
AMOUNT •
TOTALS
OK TO PAY - - PAYING UNIT NO 5477
(AUTHORIZED SIGNATURE)
CHECK NO
(DATE)
ACCOUNTING COPY
PAYING
UNIT NAME
(If afferent)