1986, 12-01 Permit App: 00014369 Remodel r (THIS IS NOTA 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 plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
' Project Number
Owner's Name LAST FIRST MI
Project Address(Street Name&Number) Zip
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Applicant Address
City State Zip Phone
Sq( )q z4- e., --27 6,
Business Phone
(5. ?) 5 '.- G- l .__O/
Contractor/Agent Address
City StateZip Phone
( )
Contact License Number(Required) Business Phone
Architect/Engineer Address
City State I Zip Phone
I ( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
(
Describe Work Res. Comm.
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Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number Lot Block Plat Number
Pertinent Ale Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft,/Acre) Depth Frontage
i.
lLeft Setback Right Setback Rear Setback R/W Width
3t L 7
. . Square Footage
c 2.
Z
Q
INtit 20
IL
Z_
Z
-,,,.,:!,!.,„:„;....,:,,--....i,::,,,•,:—.,.. ,, CO Number of Bedrooms
Group Type
.