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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 . t—E 7 r C if r S(3 0 kc, v,sz �_i 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. ' 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 .