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1986, 04-07 Permit App: 00010348 Addition (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 c /FIRST MI v.5 ii 1._ ,e.....r 0 y Project Address(Street Name&Number) Zip L. / 03 is se t, : n3-c , Q. ICI SleoKc ie tea , 79a0C ' Applicant 1 / Address VO rl .A 14e1c1 © ,1\ b 10315 Ser:n -\I'e I of CityState Zi Phone SP0k �h � 1A)cty 6 (507) 72_2_- 4-7 1 y Business Phone ( I Contractor/Agent Address City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) /•---- Architect/Engineer Address City State Zip Phone I ) Contact Business Phone ( ) Lender Address City State Zip Phone ( ribe Work Res. Comm. °.ivision/Plat Name/Short Plat Number ,,+w y C ti-t:',' i •ssor Parcel Number Lot • Block Plat Number inept File Numbers Zone 6 Cog) Comp.Plan Census Tract ', ber of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage t Setback - Left Setback Right Setback Rear Setback R/W Width N.; •itional Information Square Footage z 0 F= a 0 a z z ,, .-4 ' b .m m Number of Bedrooms agTechrt 'O Date Group Type -- ------- - ----T----- -- - - - -- T - 1 - � -- --�- � f - , , 4._.h 1___. / | _ ... � i. diga ( 1, i___H , . - i -1 r . 1 - 1 1 _ 1 I f--- -i--- , ...._..._ I, ..:h | _ MEM PI / it. _ , 1 W -- | -- ' ^' 11 - -- - -- - ----� -- / i--'- _ - - ----�| ' T| f-^� / . -�~ � - , +. ` � , :IHH't-LIHI - -|---�--- _ / -| | �� � | i|11.11- � _ | - --�- --- - - �`� \_ |- - |- - |T- | . ------| - ---r - ' / ' __ . �. � � | 1 , | ` 1 i .. - ME