1987, 06-11 Permit App: 87001716 Poolxxxxxxxx*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*xxxxxxxxxxxxxxxxxx*xxx*xxx*
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INFORMATION WORKSHEET
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/�
4Y
x
x
x
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PARCEL NUMBER:
x
lz o — �,3--t4
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/4-
STREET ADDRESS:
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CITY/STATE/ZIP:a[�
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nn
x
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SUBDIVISION: I, TLS
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BLOCK: LOT: I ZONE:-:5M DISTRICT: r
x
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LOT AREA: (` F/A: WIDTH:-Z-`DEPTH: 1201 R/W:50
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# OF BUILDINGS: # OF DWELLINGS:
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OWNER: T r40 �i�S C-Nm-r PHONE:-66f. -% ?F14
x
x
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MAILING ADDRESS:- TylT ' �-
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CITY/STATE/ZIP:
x
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CONTACT: Aeo-) s:d tA i.kl PHONE:
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x
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SETBACKS - FRONT: LEFT: RIGHT: REAR:
x
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PERMIT USE:
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BUILDING INFORMATION
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x
x
x
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CONTRACTOR LICENSE NO.: t4t-s
x
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(7'
CONTRACTOR- �S PHONE: Fv -n7�
x
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MAILING ADDRESS:
x
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ARCHITECT/ENGINEER: PHONE: - -
x
x
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MAILING ADDRESS:
x
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NEW:X REMODEL: ADDITION: CHANGE OF USE:
x
x
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DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
x
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BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.
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_
x
*REGUIRED PARKING: # HANDICAP: SEWER:(Y/N): HYDRANT:
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-r