1986, 10-06 Permit App: 00013462 Garage(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)
io)eci Number
Owner's Name LAST FIRSTMI
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Project Address (Street Name 8 Number) / Zip
F if309 CL w.e,)(1— ?Mil
Applicant (�J W)
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Address
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City tate
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Zip
4gig 16
Phone
(Soq) 9251 13at
Business Phone
SO?) Y6i OSDD
Contractor/Agent /
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City
S79bkakt_
State
Lett_
Zip
Phone
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Contact
License Number (Required)
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Architect/Engineer
Address
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State
Zip
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Phone
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Contact
Business Phone
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DEPARTMENTAL REVIEW
;.?
Approved
Cond.
Approval
Hold
Environmental Health Application 8ACS-6
W. College
Roomm 2 200
• 4
0Li
1 g,
Planning/Zoning
N. 721 Jefferson
Engineers
N.811 Jefferson '
•
Utilities
N. 811 Jefferson
' a
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