HomeMy WebLinkAbout1986, 04-15 Permit App: 00010579 Residence(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
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EfEnvironmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application # O 6 752-6
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Appproved
Cond.
pproval
Hold
Planning/Zoning
N. 721 Jefferson
_/ Engineers
L� N. 811 Jefferson
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
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Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
Phone
Address
I certify that I have examined this appllc
by me or my a nt compile said appli
Signatu
state that the information contained in it and submitted
Ion i rue and correct.
Date
BEST ROAD
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I 180 ago'. A. CAN? Pisa
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Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Ughting
Signage
Shorelines
Highwater Mark
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Scale:
Date:::
Revisions:
Attachments: