1985, 10-25 Permit App: 00008370 Repair Fire Damage No
r ' (THIS IS NOT A PERMIT)
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 _
I Project Number !6
Owner's Name LAST FIRST MI
Project Addre s(Street Name&N:mber� Zip
Applicant Address
City State Zip Phone
( )
Business Phone
( )
Contractor/Agent \ Address
City tate - Zip 9-.'._0/9
Phone
�' • C".1r � Soq) c/3- 6 97 y
Contact License Number(Required) Business Phone
1\)OPT 37/ NC 61 ( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
(
Describe Work / Comm.
-..e.e-21‘7,/ a--<°-.4 _,..Alilir F..1.Ler>1.1,-.-4-4., ---4--"CO
Subdivision/PI t Name/Short Plat Number
/-ILL cN/&fCus AUL)
Assessor Parcel Number Lot Block Plat Number
�h c'/-
1 / — r 5
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Jam_
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additiona,11 formation Square Footage
O
C-.l w _ 3
Z
0
% a
2
cc
0
u.
z
0
z
a
J_
5
m Number of Bedrooms
Building Technician Date Group Type
C- 1'-3 vt•J