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1992, 06-24 Permit App: 92004684 Reroof °VD,- IAc081-1 (O ,AO INFORMATION WORKSHEET . 'J1, !• PARCEL NUMBER: STREET ADDRESS: agR b CITY/STATE/ZIP: (//A1_,&67 , / /7/11_. SUBDIVISION: BLOCK: •_ • LOT: ZONE: DISTRICT: LOT AREA: - :-F/A: WIDTS: DEPTH: R/W: # OF BUILDINGS: - . # OF DWELLINGS: .WATER DISTRICT: OWNER:),& J , i_ 2 s0' -. 90?9L1077g PHONE: • MATT.TrTG ADDRESS: . ..z2w1)r CITY/STATE/ZIP: //,fiL�. t(9a. 990-3? CONTACT: - PHONE:- - - SETBACKS: - FRONT: -- LEFT: RIGHT: • --- REAR: PERMIT USE: 100 ,6' Zig hi 1-4-4 - £ 1 30 **************************************************************************** BUILDING INFORMATION CONTRACTOR LICENSE ND ER: 5£- /412-..see- 2/19 r CONTRACTOR: )4t2.Q AQtflhII - PHONE: 59 - MAILING ADDRESS: (� � j� t� E zea. 9?c O ARCHITECT/ENGINEER: . . PHONE:- - • - _ - MAILING ADDRESS: / NEW: REMODEL: 1/ 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:_____ INV ICE RECAP AND DISBURSEMENT VOUCHER PAY TO /.I_�.I_/ ., �4 I I_Ii. , _ ,,_ _ 1 No. 780608 STORE NO. y07gi STORE DATE 6 -/ 9 - A OUNT ALLOCATION OF EXPENSE—FOR INSTALLATION OFFICE USE CUSTOMER'S NAME SALESCHECK JOB I.D.NO. DUE ACCOUNT I DIV. CONTRACTOR MEMO NUMBER WORK ORDER NO. CONTRACTOR NUMBER NO. ADJUSTMENT ACCT. ACCT. EXPENSE SELLING is----(p gel . •..„ f EV 4. orio c e�. A _. P� . /Po' t/)d . ._ 1. a 1 I certif y P h��nstallations listed above have all been TOTAL �,/ completed satisfactorily in accordance with the speci AMOUNT 7Q/ & TOTALS .8 gY fications furnished me. /U OK TO PAY PAYING UNIT NO. k.7? .7 (AUTHORIZED SIGN'TUR PAYING CHECK NO. 1----- UNIT NAME (CONTRACTOR'S SIGNATURE) • (Dc' ') (If Different) 14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT ACCOUNTING COPY