1985, 07-23 Permit App 00006512 Patio Cover(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
ShiAULU AMtA $ Atit I -UM UtNAM I Mthi I AL Ubt
Project Number
Owner's Name LAST FIRST MI
Project Address (Street Name & Number) Zip
E -1 ia-k_S .o v\ A'U - q D 1 z..
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
Contractor/Agent
So\cd S _\AA ,Q v (
Address
.,7 to - vvy ass i
City
Z.co Ci \e
State
1LD0.91n
Zip
Qq o (
Z
Phone
(5')9) @ E3 a970
Contact
License Number (Required)
Business Phone
LOQ.<( �9) 444S -0.D i 7-
Architect/Engineer
Address
City
State
( Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
(
Describe Work 14440 CO 0 dN )(/ 9` 11\1 � S f44 (0' )Cla l
Res.
Comm.
SubdivisionlPlat Name/Short Plat Number �J %
i A\ 1VY� (1,
Assessor Parcel Number
(35*3) =02(o
Lot
C0
Block
2
Plat Number
Pertinent File Numbers
Zonec
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
Additional Information
DEPARTMENT USE 1
Square Footage
Group
Type
Building Technician
Date