1985, 09-09 Permit App: 00007334 Storage Buildingr
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF TI -IE 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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Project Number
Own,e/r.l? Name LAST FIRST MI
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(?-e-ec
ect Address (Street Name & Number) Zip
Applicant i
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Acldress
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City ,/
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State
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Zip
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Phone
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Business Phone
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Contractor / Agent
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Address
City
State
Zip r-----
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect / Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
----
City
State
Zip
Phone
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Describe Work
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Res.
Comm.
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Subdivision/Plat Name/Short Plat Number
5 (-)-Pc="
Assessor Parcel Number
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Lot
Block
Plat Number
PertinentFileNumbers
Zone
Cornp. Plan
Census Tract
Numberof Dwelling Units - •
Number of Buildings • - -: .-
Lotglze-gicr.,ft.iAcre) - .
Depth -Frontage
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Front Setback
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Left Setback
Right Settrck
Rear Setback
Additional Information-
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Footage ._ .
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Building Technician
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Date/ /
Group rType
to- 't 1 -
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
W. 1101 College
Room 200
Permit Number
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
Other (SEPA/Crlticai 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 agent is true, correct, legal, and binding.
Owner's Signature Date
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