1985, 09-16 Permit App: 00007478 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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Project Number -p1-7,8
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Project Address (Street Name & Number) ` Zip
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Business Phone
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City
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Phone
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Contact
Business Phone
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Lender
Address •
City •
State
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Phone
Describe Work
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DEPARTMENTAL REVIEW
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 —�! "'^'w --
A
:WvW"1,.0 _-_. Date v9(fro (D5
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
�i�Y
APr'" /'/'
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
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Engineers
N. 811 Jefferson -
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Utilities -',
N. 811 Jefferson -..
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Plan Review/Fire Prevention ._
N. 811 Jefferson . -
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
-
Project Representative
Phone
Address
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 —�! "'^'w --
A
:WvW"1,.0 _-_. Date v9(fro (D5