1986, 10-28 Permit App: 00013976 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 applipation is true and correct.
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Signature
Date/°/
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Approval
Hold
Environmental Health
W. 1101 College
Room 200
Application #
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Planning/Zoning
N. 721 Jefferson
Engineers
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Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
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 applipation is true and correct.
J/'.irk -
(1,1
Signature
Date/°/
/.2-f4
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