1993, 09-08 Permit App: 93008112 Reroof 151 LPJm 113 q3 (2,
li APPLICATION WORKSHEET 1
General Information y
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I`, Site Information
Legal Descnptioa
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Project Information r � � 0 - o75 �5_,
�Yermit Use
I0dditioa I Remodel 1 Chaaago of use 1
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L Building information 111 -
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LContractor Information
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L�PROJECT CONTACT' PlIONE
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DEPARTMENT OF LABOR AND INDUSTRIES
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW ASA
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