HomeMy WebLinkAbout1986, 10-27 Permit App: 00013980 Duplex(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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Owner's Name LAST FIRST MI
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Project Address (Street Name & Number) Zip
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Applicant
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Address
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CityState
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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
Phone
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Contact
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License Number (Required)
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Business Phone
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Architect/Engineer
Address
City
State
Zip
Phone
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Business Phone
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Lender
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City
Stat
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Phone
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Lot $
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Plat Number
Pertinent Fite Numbers
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Number of Dwelling Units
Number of Buildings
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Lot Size (Sq. Ft.lAcre)
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Frontage
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BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building
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Technician
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Date
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Group
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Type
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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 /0 9/f6
Approved
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
Engineers / / , /
N. 81 Jefferson �.0..19.,./ , i1_
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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
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
Date /0 9/f6
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