HomeMy WebLinkAbout1986, 09-23 Permit App: 00013267 Storage(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 LAST FIRST - MI
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Project Address (Street Name 8 Number)- Zip
&DS • �B Wio )SN•Si%y4/'s (614 9 92-0
Applicant (—' - -
Address
City
State
Zip
Contractor/Agent
57,
Phone
q (0291 9STt- ..
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Address
City
State
Zip
Phone
)
Contact
Architect/ Engineer
City
License Number (Required)
Business Phone
Address
State
Zip
Phone
)
Contact
Lender
City
Business Phone
)
Address
State
Zip
Phone
)
%Zone?
NCrimp.sP
Number:- Buildings
Census Tia'cf
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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
• Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage.
Shorelines
Highwater Mark
Legal Description
14.4Orrirkkrarrrirc...Csitorr,orrrIkrir“trIr.3eMiSiorirS:',0•414.44flt•11,;$0.001‘1141.r.
Scale:
Date:
Revisions:
Attachments:
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DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental/``
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Health Application ft / g3 /-1,,
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Collegee
Room 200 7
1
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/CrItIcaI Material/etc.)
Fast Track/Special Inspection Information
Protect 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.
Signatu