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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 �/ 9 Applicant Address City State Zip Phone ( ) Business Phone Contractorr/l��t ..,, // Ze Ad �O����' .d t_e���1 City //���/ State (/ Zip Phone 0-07 'f) c� -6'�r t 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. : � ° s' barF��EC tf ber„� Lot Block Plat Number �: 7-44 a + '+ te - a * 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 � .. ++ - t•� x, Square Footage ', '-' Z o ' Rz Q . s. a O2C kr O ,,,3 , tL 'c q ;` .mss g Z ' - — '� � 0 COD Number of Bedrooms .T a - ¢, z Date Group Type