1986, 09-05 Permit App: 00012987 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 Satety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
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DEPARTMENTAL REVIEW
N..
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
-Owner's Signature Date
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Approved
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Cond_
Approval
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Hold
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Environmental Health Permit Number
W. 1101 College
Room 200C
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2-11-
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Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
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Plan Review/Fire Prevention
N.811 Jefferson
Other (SEPA/Criticai Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
N..
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
-Owner's Signature Date
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