1988, 12-20 Permit App 88004069 Re-RoofF ccc r (vNAT- Yc(< C���v o�u F � P,�� dv��� /. ecu
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x INFORMATION WORKSHEET "
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* PARCEL NUMBER- / x
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* STREET ADDRESS:-.&-
CITY/STATE/ZIP:
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* SUBDIVISION: 13A 9 ir-S�� *
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*
BLOCK:—LOT:—ZONE:—DISTRICT-
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* LOT AREA: F/A: WIDTH DEPTH R/W:
x
*
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* # OF BUILDINGS: # OF DWELLINGS: x
x
OWNER -
PHONE: z
* /'ail Y' �� ��11,
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* MAILING ADDRESS- ' x
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* CITY/STATE/ZIP: n 6r-cl
* CONTACT: PHONE: _
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* SETBACKS - FRONT: LEFT: RIGHT: REAR:�,�S-d367
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* PERMIT USE: /?e tea Ch��c S Q s '_ l r e vd �l �/).+ h ce r ct )f x
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x .BUILDING INFORMATION \/A(uATlev A"ru4,7
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* CONTRACTOR LICENSE NO.. 114/n/ iF
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* CONTRACTOR: fir" ,;k- N Pr' AI X, Lj o PHONE :5 35= '21 - 3 /
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* MAILING ADDRESS:- 3 3,o 3
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* ARCHITECT/ENGINEER: PHONE:— —
*
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* MAILING ADDRESS:
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*
*
NEW: REMODEL: ADDITION:_ CHANGE OF USE:—
*
*
* DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
*
*
* BUILDING DIMENSIONS: K (WIDTH R DEPTH) SQ. FT.
*
*
*REGUIRED PARKING: # HANDICAP: SEWER:(Y/N): HYDRANT:
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* NGPILE FINE 1NFCRT'AI,ICN
* CCNTR LICA: ------------
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* CONTRACTOR:
#
--------------
* MAILING ACCRESS:`
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# PREVICLS ADDRESS: -----------------------------
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* LOCATIGN:------ PARCEL NLMPER:#
#--––––––– – – – – –– – – – – – – – – – –
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# STREET:
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* CITY/ST ATE /ZIP:_—_
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# RELCCATICN INFCRPATICN
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* CONTRACTOR:__
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# MAILING AJCRESS:_____________
# --------------------------------------
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# PR EVICUS ACCPF.SS:
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#
# LLCATICN:------ PARCEL NUMBER:
#
# STREET•.
a CITY/STATE/ZIP:
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SIGN INFCRMATICN
F CONTR LICA:
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k CONTRACTOR:__--
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-- #
k MAILING ADDRESS:________________—_--
#
#
k SQUARE FOOTAGE: ____–_– POLE FEIGHT:___—__
#
k
1
#
44
' DEMCLITICN INFCFMATICN
#
CONTR
' C O N T R A C T O R:--------------------------
MAILING ADDRESS:_______
-----------
BUILCING SCUARE FOCTACE:
NUMBER CF BUILCINGS:—
#
#
# CO+N T R L I C#:------
#
# CONTRACTCR:-----_
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# MAILING ACCPESS:--
PLUNBINC INFORMATION
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#
PFCNE:--__ --- °
#
-----------------
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# MELFANICAL INFCRMATICN
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# CON TR LIC4:---------------- — #
# CONTRACTOR'-----------------'---------------
— — — — — — —--
#
z
# MAiLINC ADCRESS:------------------------------------------------ -- %
#
# ELECTRIC:—_ LAS:--- CIL:— —— CCAL:—_ WCGD:--- SCLAR:--- FEAT FUNF:--- f
k
#
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MECHANICAL FEES PLUMBING FEES
ITEM OESCRIPTICN
------------------------
PROCESSING FEE
DUCTWORK SYSTEM
wOCCSTCVE/INSERT
GAS WATER HEATER
GAS HTG EOUIP<IOC,000>BTU
6AS HTG EQUIP+100,000 BTU
GAS PIPING — # OF UNITS
HEATPUMP 1-100M P.TU
HEATPUMP 101-500N BTU
HEATPUMP 501-1,COOM BTU
HEATPUMP 1,001-1750M BTU
HEATPUMP +1,750M BTU
REFRIG 1-100M BTU
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
kEFRIG 1.001-1,750M BTU
REhRIG +1,750M BTU
AIR CONDITIONER 0-3 MP
AIR CONDITICNER 3-15 F.P
AIR CCNDITICNER I5 -3C HP
AI P. CCNCITICNER 30-50 HP
AIR CONDITIGNER +50 HP
VENTILATING FANS
EVAPORATIVE COOLERS
HOODS
CLOTFES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10GOG CFH
AIR HANDLER 10000+ CFM
NUMBER CF
YES OR NG
ITEM DESCRIPTION
-------------------------
PROCESSING FEE
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPCSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOCR SINKS
BAR SINKS
ROOF CRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URNAL
DRINKING FOUNTIAN
NUMBER OF
YES OR NC