1986, 10-16 Permit App: 00013668 Garage(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)
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DEPARTMENTAL REVIEW
1 certify that I have examined this application and state that the Information contained in it and submitted
by me or my agent to compile said application Is true and correct.
Signature Date
Approved
Approval Cond.
Hold
Environmental Health Application # -
SD"'
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m1101 College
200
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
Phone
Address
1 certify that I have examined this application and state that the Information contained in it and submitted
by me or my agent to compile said application Is true and correct.
Signature Date
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TRUCTURES
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Additional Information:
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Lot Dimensiens ~
Existing.Structures -
Proposed improvements.
StructureSettiacks ,•
:Easenients ' ••
Septic,System (s) . •
Water Lines -.
Sewer.Lines ..: • • •
Fences, Wells
Driveway(s)
Right of Way Width(s)
Flames of
Fronting Street.
Flanking Street
Landscaping • .•
Drainage Plan • - •
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Hydrants
• Topography . .
.'Lighting
Signage
Shorelines • - .
HighwaterMark:.
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