HomeMy WebLinkAbout1985, 08-27 Permit App: 00007129 Addition(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 7/ 9
Owner's Name LAST FIRST/44 M
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Project Address (Street Name & Number) Zip
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State
Zip
Phone
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Address
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State
Zip
Phone
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Contact
License Number (Required)
Business Phone
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Architect/Engineer KAddress
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State
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Zip
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Business Phone
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Address
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State
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Date
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Type -
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Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number
Approved
Cond.
Approval
it)(6-Qj
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
Other (SEPA/ Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify tha�have examined this application and state that the information contained in it and submitted
by me or my .. nt is true, correp't gal, and b,ing.
Owner's Signature
br.. " (.{' Date
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