1985, 11-06 Permit App: 00008541 Garage 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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I Protect Number�5
Owner's Name LAST % FIRST MI
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Project Address (Street Name & Number) Zip
CX26' 0/1 gG " 21.x._2 S. -e-, 79‘).3 7
Applicant
1JR4-I O e-i..e4Y C]
Address ��,/
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City
State
Zip
Phone
Business Phone
( )
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
Zip
Phone
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Su1J41/Yision! last Name/Butt TMH
Assessor Parcel Number
2555t/ - 0503
101
Biotic
Plat Number
Pertinent File Numbers
Zone
Comp. plan
Cana Tract
Number of Dwelling Unita
o
tot Size We. FL /Acre)
Depth
Frontage
Front Setback
Let
n
o Night8etbaok
Rees
R/W Width
Additional Information
,
z
Square Footage
0
t
2
z
Ili.
z
0
z
W..
CCI
Number of. Bedrooms
Building Tec niclan
t/ -r/
Group
Type
vN
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 G� Date /1/6
Approved
CpApproval
Hold
Environmental Health Application #
�/�
W. 1101 College C,�` - ,E7
Room 200 �J
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
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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 agent to compile said application is true and correct.
Signature G� Date /1/6
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