1985, 10-22 Permit App: 00008236 Fire Damage(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
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(Please return this original and your building plans to the Department of Building and Safety)
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Project Number (�i( - 5 (fJ
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Owner's Name AST FIRST MI
Project Address (StreetZip
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Applicant p�•
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Address
20 7 E 0Ag L A k d
City
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State
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Zip
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Phone
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Business Phone
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Contractor/Age%_,
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City
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State
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Zip
9 .s -c7
Phone
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Contact
/jicense Number (Required)
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Business Phone
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Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
( )
Describe Work
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Res.
Comm.
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
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
R/W Width
Additional Information •` /�(� M` \ j
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1 BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
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Date
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Group
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Type ,
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Show on Site Plan:
Additional Information:
Lot Dimensions
Landscaping
Existing Structures
Proposed Improvements
Drainage Plan
Hydrants
Structure Setbacks
Topography
Easements
Septic System (s)
Lighting
Signage
Water Lines
Sewer Lines
Shorelines
Fences, Wells
Highwater Mark
Driveway(s)
Right Way Width(s)
of
Names of
Fronting Street
Flanking Street
Legal Description
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Date:
Attachments:
Revisions'II
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