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1992, 09-11 Permit App: 92007513 Reroof Li5 '- Q4oa qa - -7513 veca 0),Aerr(1 Aa I--2 • INFORMATION WORKSHEET 9g' __ • PARCEL NUMBER: STREET ADDRESS: /Y 7/ -- / '4-et-- CITY/STATE/ZIP: zi (JJa q 'c 32 • 1 , SUBDIVISI02f: . BLOCH: LOT:__ ZONE: - DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: .WATER DISTRICT: OWNER: ( 62.-C-j P -n ©i PHONE: - - MAILING ADDRESS: /L/6/4/ / 3 _ CITY/STATE/ZIP: (/. _ l i L q90 52 CONTACT: - PHOrix:• _ - - - SETBACKS: - FRONT: LEFT: RIGHT:_ REAR: PERMIT USE: (s?.e_ g9-6)-z)/ () e_ i _ 095- **************************************************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: $ ///0 ,_ ,SE- -7JL 7- CONTRACTOR: g_ / ,(Q _ PHONE: 5-0_ -1-4=D- -5708s- MAILING 5708sMAILING ADDRESS: PQ l 3-7 D-7 , o / (-0q Gf 9 a) ARCHITECT/ENGINEER: PHONE: - - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SEWER (Y/N) : HYDRANT: %�_ �� e.„...„_. I �l� ,� PAv To ;NVQ ICE RECAP AND DISBURSEMENT VOUCHER No. 780428 STORE NO. '7 Df79 STORE f aLa._,,(_Q_ DATE 9- /- q D.--- SALESCHECK JOB I.D.NO.OR AMOUNT ALLOCATION OF EXPENSE-FOR INSTALLATION OFFICE USE CUSTOMER'S NAME NUMBER WORK ORDER NO. DUE ACCOUNT DIV. CONTRACTOR MEMO CONTRACTOR NUMBER NO. ADJUSTMENT ACCT. ACCT. EXPENSE SELLING X�-iA RB e- i ph., a 33-1 '28 Sig 43S2.. '2g . /q i4- / 3 k A � - ,7,,, , I certify that the installations listed above have all been TOTAL �r.� completed satisfactorily in accordance with the speci AMOUNT 9gr 81 TOTALS 781"7 ` I ' fications furnished me. OK TO PAY PAYING UNIT NO. c/(2 (AUTHORIZED SIGNATURE) PAYING CHECK NO. UNIT NAME (CONTRACTOR'S SIGNATURE) (DATE) (If Different) 14489(See Bul.0-187 Part II Supp.8) REV.3/91 SEARS FORMS MANAGEMENT ACCOUNTING COPY