1985, 08-15 Permit App: 00006951 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)
SHADED AREAa ARE FOR DEPARTMENTAL USE
I Project Number / ;� C,1
U
Owner' 1 e L T �/� FIRST MI
Project A dress (Street Name & Number) Zip
1�1. 12-1(0 130wD(St1- R o 1 6
Applicantn
<-0B-E-YLT e , Ac (c. ---}//, k--- X
Address
City
041.17\
Stat
Zip
Phone
Business Pho
Contractor/Agent
rState
Address
City
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( 1
Architect/ Engineer
CMZ (-----
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
hL0 N
Address
City
State
I Zip
Phone
Describe Work
iN Ti €.c.NMcp G (1.- 42--0,c4c C ISk `` k 2y)
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
oWocz,-turtkirry
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent Flie Number,
Comp. Pian
Census Tract
Number of Dwelling Units
1
Number of Bulldinge
Lot Size (Sq. Ft. (Acre)
DepthI
4E545tePr
Frontage
Frtatt t
twit Setisac =
Right Setback
i#sst Setback
Additional tnlormation
1N(U.IDE UL)06
ENT USE
1 DEPARTM
Square Footage
3(00
Budding Tachnlclan
Date
Group
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 age true ,correc), Imo, a04 binding.
Owner's Signature �f 2 Date
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
/ /l
�0(�70
1 t
p•
' , 1
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my age true ,correc), Imo, a04 binding.
Owner's Signature �f 2 Date
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