1986, 07-14 Permit App: 00012083 Relocate 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 AREAS ARE FOR DEPARTMENTAL USE
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Owner's Name
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Project Addr (Street Name & Numbar) Zip
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Applicant _
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Address
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State
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Phone
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Business Phone ----
Contractor/Agent
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/ Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
Describe Work C
Res. J
Comm.
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Pian
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./ Acre)
Depth
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Frontage
'
(bn
Front Setback
Left Setback
Right Setback
Rear Se
R/ W Width
Additional Information
Square Footage
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Number of Bedrooms
Building Technician
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Date
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Group-
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 Date
J_
Appro��
Cond.
Approval
Hold
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Environmental Health Application 01
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
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Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Materlal/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 agent to compile said application is true and correct.
Signature Date
-4
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