1986, 06-10 Permit App: 00011513 Garage(THIS IS NOT A PERMIT)
BUILDIN -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)
SHADED AREAS AR
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Project Number 'i5 i3
Owner's Name LAST FIRST MI
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Project Address (Street Name & Number)
Zip
N 3. 3,2 / bEST SP0X4VF OA. 94.216
Applicant
Address
City
State r
LIP
Phone
( )
Business Phone
( )
Contractor/Agent ..
Add -ess
City
State
Zip
Phone
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
I
Zip
Phone
( )
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
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Subdivlslan/Plat Name/ Plat Number
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Zone
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Number of Dwelling Units x
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Number of Buildings v
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Lot Size (Sq Ft /Acre) -
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Depth • `
Frontage
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Square Footage
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Number of Bedrooms
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Date?
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Group
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Type
DEPARTMENTAL REVIEW
I 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
-/6 ijrijl -
Date
6 —/
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Approved
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Cond.
Approval
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Hold
Environmental Health
W. 1101 College
Room 200
Application #grt _I d c 0
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Crlticai Material/etc.)
l•'
Fast Track/Special Inspection Information
Project Representative'
Phone
Address , y
I 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
-/6 ijrijl -
Date
Show on Site Plan:
Additional Information:
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Lot Dimensions
Landscaping
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Existing Structures
Drainage Plan
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Proposed Improvements
Hydrants
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StrcctureSethacks
Topography
Easements
Lighting
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Septic System (s)
Water Lines
Sewer Lines
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Signage
Shorelines
Highwater Mark
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Driveway(s)
Rnht of Wall Widths
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Fronting Street
Flanking Street
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