1986, 10-28 Permit App: 00013975 DuplexDEPARTMENTAL 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.
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Date
0/,2 AZ,
Approved
Cond.
Approval
Hold
Environmental Health
W. 1101 College
Room 200
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Application # ____4(_L/y/
Planning/Zoning
N. 721 Jefferson
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N. 811 Jefferson ` 1J
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Utilities
N. 811 Jefferson
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Plan Review/Fire Prevention
N. 811 Jefferson
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.
(/alb' e,'7<" C,ZI
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Signature � � -f.,eC, t."_,-4='
Date
0/,2 AZ,
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