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1992, 05-20 Permit App: 92003571 Reroof 054-131 a4 CAa - 3s1 I INFORMATION WORKSHEET C_____:-______ 4 L\520-t' .. .. PARCEL NUMBER: STREET ADDRESS: / b LY 0 / < CITY/STATE/ZIP: . Cic o C1 c c SUBDIVISION: . :BLOCK: - IAT: ZONE: - -`DISTRICT: LOT AREA: • F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: .WATER•DISTRICT: - OWNER: ,.��,J:�51-v� _, w ✓�Y�,L �)� d� PHONE: - - MAILING ADDRESS:"_ 1 (J Li O - 'S. _ ---- CITY/STATE/ZIP: ,4:. �:-2 . , ( ,tJ C� ' Rq c- O Co CONTACT: _ PHONE - SETBACKS: FRONT: LEFT: RIGHT: -REAR: PERMIT USE I Q@ ' 3 n 0/ .Q </,°l 4--C�'� o,o *********************i**********use****************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER:SG- 11 ( -Sl - 3'1 - IU T- CONTRACTOR: / 0 , PHONE: --(.)q - Alai_ I ( �,,, MAILING ADDRESS: pc) ►P, C-.)--1 •4 .1 -.A_Ei WCC .qq � CD ARCHITECT/ENGINEER: - PHONE: - . - - MAILING ADDRESS: NEW: REMODEL: \ ADDITION: CHANGE OF USE: DWE' i UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUIL;iING DIMENSIONS: K (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SEWER (Y/N) : HYDRANT: PAY TO 4 e% 1'liii / 1� ; I t. !ilii ' I VOICE RECAP AND DISBURSEMENT VOUCHER LiQ�q No. 8081 4 STORE �NO/.� STORE !4J eQ _ DATE /-9 — 9_ 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 aD- c meA o A 51--((vs 3 6S /8 33'-7 (a& ` 1` °r ( 0L-(©a 1 - P1 .i 1 t--,4— • I cer ify that the Installations listed above have all been TOTAL completed satisfactorily in accordance with the speci AMOUNT bg 4922-_ TOTALS WA----- --H.," ---- fications furnished me. OK TO PAY PAYING UNIT NO.- 74 79 0--/c) (AUTHORIZED SIGNATURE) /1/ 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