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1985, 11-12 Permit App: 00008637 Residence
(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) 01-111L/CIJ Mn C/1A FAME r vn L/CrpAn 1 IVICIV 1 FAL VJC Project Number e63-7 Owner's Name LAST FIRST MI ',2....3% 4 t4' /a -77s -r- �I s�j�ni ' Project Addr (Street Name & Number) /Zip // Applicant Address City State Zip Phone 401. Business Phone ( ) 9 1 z Contractor/Agent /v � Pimei— A/..X/an.,,,� Address ,-1,%,‘...1 /' A. .... City e/ State / / r03 p�e19 Z / ,%,/ Phone Contact �.�� G� 7 , License Number (Required) ‘.5'7 .'/-/f Xi. f41 Business Phone ( ) Architect/Engineer / Address City State Zip Phone ( ) Contact •Q +� d� viB1 Business Phone ( ) Lender Address City State I Zip Phone Describe Work 61 06/Q CE c v%G•AR4 C--- Res. Comm. Subdivieion! Plat Name/Short Plat Number Asaes4or Parcel Number 275411 Lot Block Plat Number Pertinent File Numbers Zonei Comp, Plan Census Tract Number of Dwelling Unite 1 Number of Buiidktge 1 Lot Size (Sq. Ft./Acre) Depth Frontage Front Setback cJC/\� Lett Setback Right Setback Rear Setback R/ Wth Additional Information 1 BUILDING INFORMATION Square Footage 1214=l -IF /274 -u8 ©=C-/-R Number of Bedrooms Building Technician gait) (]ate 11-- /2 - _ Group IP- 5 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 Date Approved CpApproval Hold Environmental Health Application # W. 1101 College Room 200 C k 7 X130 ` l -13 fVI �6 Planning/Zoning N. 721 Jefferson Engineers/N. 811 Jefferson TN 4-- " C�/ Utilities N. 811 Jefferson I Plan Review/Fire Prevention N. 811 Jefferson �a�--t/■ , ii X311 Other (SEPA/Critical 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. Signature Date { 4