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1991, 07-24 Permit App: 91004475 Reroof
INFORMATION WORKSHEET PARCEL NUMBER: I,(7/ 1k STREET ADDRESS: //3/L) CITY/STATE/ZIP: ,0. )2_ / JPt SUBDIVISION: =BLOCK:_ LOT: ZONE: --DISTRICT:DISTRICT: LOT AREA:` -F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OP DWELLINGS: .WATER•DISTRICT: -� OWNER: Y" i d//1 ( /0(2,(.1--1,6(--11 PHONE: . z)1 - - 55 9 MAILING ADDRESS //310 CITY/STATE/ZIP: 40AL__ka,„1,t_e am- CONTACT: - . PHONE:- SETBACKS: HONE:-SETBACKS: - FRONT: .. LEFT: RIGHT: -REAR: PERMIT USE: ; Apoey th (9C2 cis ( ********************* ****************************************************** BUILDING INFORMATION - CONTRACTOR LICENSE NUMBER: C. -/l ( -S-(Q a�7 1 CONTRACTOR: aPittAlb ( /'YIa- PHONE: 57319 - q //-7o X3c/4 MAILING ADDRESS: Pnla3-70 -7 f GOA- ciq` o n ARCHITECT/ENGINEER: PHONE:, - . - . - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWE' UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUIL +ING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SEWER (Y/N) : HYDRANT: