1985, 11-14 Permit App: 00008692 Fire Damage Repair(THIS IS 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)
Jm MUCU MFt MJ An= run utrMn I IVI CIN IML UJC
I ^ � l 2...,Project Number 8
Owner's Name LAST FIRST MI
eft 6a(1 2O6ez
Project Address (Street Name & Number)Zip
E. geoz_ /lOI'e49- si204.4re_
Applicant
SE2VCp5.rrlP2,iiEs� tr..
Address
NL 73o COLuSlat' 3
CitySPOr. ^ 'E
IL!'r+Y
State
Zip 9./
Phone ( ) ,i89-�1Sz
Business Phone
( )
Contractor/Agent
SE2trc4_,
Address
City
State
Zip
Phone
)
Contact I
C/fiets Cut-1r//4,C
License Number (Required)
S&2JC.1_ 2,I6BY
Business Phone
( I Jig 9-5-/,5- L
Architect/Engineer i J 1. -8 6
Address
City
State
Zip
Phone
1
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
( 1
Describe Work
/-1/Aro& Fii2g. blies>46E '1/2°4r2 To 2079F ,4z.F.,¢
Res. /
Comm.
Subdivision/ Plat Name/Short Plat Number
0e 3-02[151
))
A essor Parcel Number
b PPor1NN"I,11'(- wwoo HTs .
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings _
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
IBUILDING INFORMATION
Square Footage
S. -?..) TOO 'DJ
Number of Bedrooms
Building Technician
Date
Group
Type