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1988, 12-08 Permit App: 88003920 Repair Fire Damage INFORMATION WORKSHEET PARCEL NUMBER: STREET ADDRESS: . / yG 6— /` klia CITY/STATE/ZIP: S/4 Ad/% G-' 1,$_ 9 I L t G SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT: OWNER- ,1 s //e /r> A/ PHONE: 5-11 , - ci v — 2 .a MAILING ADDRESS: E . g''l� /V it -'i !f<Zi®`/ CITY/STATE/ZIP: Aa/a _ l.(,A, 'l9 �1 CONTACT: ,FsJ, c-A. /ai s PHONE: - - SETBACKS: - FRONT: LEFT: RIGHT: REAR: PERMIT USE: ****************************************************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: PHONE: - - MAILING ADDRESS: ARCHITECT/ENGINEER: PHONE: - - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SEWER (Y/N) : HYDRANT: Revised 1/88