1986, 11-14 Permit App: 00014196 Demo Residence (THIS IS NOTA 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)
ORe.f(! SHADED AREAS ARE FOR DEPARTMENTAL USE
Owner's NameLAST RST MI
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Project Address(Street Name&Number) ` /11-1' --5;;
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Applicant
City State Zip Phone
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Business Phone
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Contractor/Ag � /lv s 611t61,1
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City State ( Zip Phone
Contact License Number(Required) Business Phone
Architect/Engineer Address
City State Zip Phone '
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Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
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