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1986, 05-19 Permit App: 00011098 Inspect Fee (THIS IS NOT A 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) SHADED AREAS ARE FOR DEPARTMENTAL USE project Number 11 4 CI Owner's Name LAST FIRST MI ,TiL/9/. /4716//5/A-Ad Project Address(Street Name&Number) Zip /// 7(4 R Ze do /fr7 spc'AL-4N 6' \/Y4 h 99i-e-', . Applicant , Address • C A A,l f C ATS A 4 (7 7 o/o/A- City State Zip Phone //V,4s 6 ?F 2-c- — ( ) �.���c�3_ Business Phone iiI 7• , Contractor/Agent Address City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State I Zip Phone ( ) Deticribe Work.,',,,,,,'-'444..-',4,1441V....� :,_ Res. Comm. S .' 1t::- 1 �{� TI©� — E)03T11\161 AOoc?/6 ✓ Subdivision/Plat Name/Short Plat Number Assessor Parcel Number Lot Block Plat Number T4''L 1 ' 7-) ( [3 17 Pertinent File umbers, Zone Comp.Plan Census Tract x NumberofDwelllingtlnits Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage e` a ;" .P Fwrtt' "t, Left Setback Right Setback Rear Setback R!W Width Addltional Information Square Footage s -;,( Z O Q 0 U- 1 Z_ a t .* 0 ., . rix- ' J l;;;;;01-4,..-..",i m " *'. Number of Bedrooms Date . 3/9 Group Type g