1986, 05-23 Permit App: 00011189 Reroof 4111
(THIS IS NOTA PERMIT) r
•
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 ` 5e1
Owner's Name
T FIRST Mt
1w .2aAi-5 c
Project Address(Street Name&Number) / Zip
2_2_ F- v4/4f - 4y
Applicant Address
mel{.'
Cit ! jj Stat Zip Phone
h '9'9 037 qa-z>
Business Phone
t )
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 Zip Phone
Describe Work Res. Comm.
1: ') — tf\
Subdivision/Pjat Name/Short Plat Number
Assessor Parcel Number Lot Block Plat Number
I 7, 3 i Vii"'i1 I ')
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
titajup,-00N) 4.8 0. 4')
z
0
2
0
t1
z_
c,
z
0
J_
5
m Number of Bedrooms
Building Technician Date Group Type