1987, 09-21 Permit App: 87000187 MH (THIS IS NOTA PERMIT)
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BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE !N INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
I Project Number
Owner's Name LAST N FIRST MI
Project Address(Street Name&Number) Zip
9 3 I -' 13
ApplicantAddress
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City S ` State r Zip
TAL
�� Phone �� ��
Business Phone
( )
Contractor/Agent Address
0 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.
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number Lot Block Plat Number
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front Setback,r,:,... Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
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0
Z
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5
m Number of Bedrooms
Building Technician Date Group Type
0
(THIS IS NOT PERMIT)
BUILDING PERMIT APPLiCATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF-THE FORM YOU UNDERSTAND
COMPLETE !N INK
(Please return this original and your building Glans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
�Proiect Number
Owner's Name LAST — — :inti T Mi
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,�112C0n.10 Slciut J_
Project Address(Street Name 3 Number)
6151 S t . 41-14 tr
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Applicant ~� Address:'
City State i _ p Phone
( )
Business Phone
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Contractor/AgentAddress —__-_-_.._.`_r,._ —_—__...—�.(
City State Zip Phone —{
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Contact License Number(Required) Business Phone
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Architect/Engineer Address '
City State ' Zip I Phone
Contact Business Phone S
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Lender t Address - t
i
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City State i Zip Phone I
( )
L .
Describe Work I Res. R ' Comm.
Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number Lot Block Plat Number
` '-{- -2- q02-4
Pertinent File Numbers Zone
Comp.Plan Census Tract
1
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
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z
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J_
5
m Number of Bedrooms
Building Technician Date Group Type
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