1985, 07-30 Permit App: 00006615 Reroof ,z/pte_; (!ev,:,2 :-___,
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's NameLAA (last)
4 �(f/i►rst) j(m) Department UpYOnIy
C� dtiiet.i _:. 9/ vat F3s. Comm
2 Project Address(not Mailing Address)or Roap N me Space Zip
S' /(p(() 1 a. .99,/.
3 City/Co unit State Subdivision/Plat Name
/f /' '� OPPO�eT6�r %5R/Me
&- 2 &il)
4 • Parcel No. Lot Block
2_7 912-
- 0502-
2_ /
* * * DEPARTMENT USE ONLY * * ,t
5 Sic Code Zone Act.# Zone A Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front 1(L)S-1 (R)S-2 I Rear Census Tract Module No. Initials
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
II ' i ' tr 4 : u .iot / ' „hi_ a Al - 6 , r/ �� �,��.
Zip / City _ State -hone / _
qqa« �� 7u - tun ( ) c���
Co tad Person License No. Phone If different than above
/40 K� !//a/ain cV .gG3�6i1� (.moo l) 92f-VV 7(
8 Owner/Agent f different than#1 ab'e) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) [SEPA Exempt(Y/N) Date
15 Type Work 0 Bldg 0 MH 0 New 0 Replace �" Other
0 Fire 0 Demo 0 Add/Alter 0 Move rep(!i-----
14
14 Describe Work -/n// �
10 Applicant Name /14.1 Street Address
11 Zip City State Phone
( )
* Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
V /jii 'i ;/ /n a, vo
1P-01A/14;41- / 00