1986, 10-14 Permit App: 00013598 Repair Fire Damage - (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 Project Number
Owner's Name LAST I RST MI
Project Address(Street Name 8.Nber) Zip
0 7 W
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Applicant Address
City State Zip Phone
( )
Business Phone
Contractorr/l��t
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City //���/ State (/ Zip Phone
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Contac ie. ' License Number(Required) Business Phone
Architect/Engineer �o�,Li II? Address ( )
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State I Zip Phone
( )
Res. Comm.
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ber„� Lot Block Plat Number
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Zone Comp.Plan" Census Tract
' Its Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
:` Left Setback Right Setback Rear Setback R/W Width
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COD
Number of Bedrooms
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