1986, 04-24 Permit App: 00010681 Garage i7Sf os 17
(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE • --
Project Number
Owner's Name LAST FIRST MI
Z fr 1 LO/(/ / 10S E
Project Address(Street Name&Number) Zip
E/a'2 v Sky✓/Ew / 5Pof�6. - l-(- S ??0''
~Applicant /�� Address
S-1.1‘" �'`E)(E12 I (4/ ?4'/5--/41E-4401-(1vlec-t/
City State Zip Phone
c1 vkiE F4-//s w1'+ - v 26 (-5-0) 1/(0G -03,g•
Business Phone
(50 )5.ay-93'4P
Contractor/Agent Address ..__._._._.�_:�er._._....�...
/eiF`veaeak ave z v Sysre- _ /5"— �
X29�segaow 4
City State 'ICZip Phone
el-ilile-�g61's w _ 99'0 2 (, O q) `z'GG — 0376
Contact License Number(Required) Business Phone
sisi 1Wxe- - s w ,,� (spy) say- ,76,
Architect/Engineer Address
City { State i Zip Phone 1
( ) E
Contact Business Phone
( ( )
Lender +� Address
City State I Zip Phone
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Describe Work Res. Comm.
Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number Lot Block Plat Number
-i5 43 v 1S-17'3 '3 [ 3
Pertinent File Numbers Zons..,r12."
Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth ) Frontage 1 ,I,
1 ( 13 0qct --
Front Setback Left Set ) Right Setback )t Rear Setback R/W Width
Additional Information Square Footage
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.'ng Technician Date , / Group Type .
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