1985, 11-08 Permit App: 00008610 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)
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Project Number (0
—•
Owner's Name - LAST;�+ FIRST MI
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Project Address (Street Name & Number) Zip
to 3 El c.574CP o
Applicant
S4/111_
Address
TOO C, c//779 (-Do
City
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Stale
A✓/9,
Zip
972/A
Phone
(507) 9,2y-4'97`/
Business Phone
Contractor/Agent
/
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
Architect /Engineer -
�/� r
Address
City
State - re
Phone
Contact
Business Phone
( 1
Lender
Address
City/�
State
Zip
Phone
( 1
Describe Work � ..Res.
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Comm.
Subdivision/Plat Name/Short Plat Number \----.
LA.1Z els Pr 1942 o
Assessor Parcel Number r
Lil ✓C-- tY 01 1
Lot
Block
Plat. Number
Pertinent File Numbers
Zone
PvG.Su
Comp. Plan
Census Tract.
Number of Dwelling Unita
1
Number of Buildings
(
Lot Size Ft. Acre)
Depth
I45
Frontage
1s
Front Setback(
4
LeftSeit k
Right Setback
Rear Setback
R)W Width
Additional Information
BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Techn''an
Date/f. *�
Group
T
id
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIkW
•
Application # / 6 I0fi
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
O N. 811 Jefferson
L
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
Other (SEPA/Critical Materiel/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined thl%application and state that the Information contained in it and submitted
by me or my agent to compile said ap'pllcation is true and correct.
[ p�
Signature {% 1 //l Date ji O g'r
DoT= 75X /y5
Fico Air Peopctry
Show on Site Plan:
Additional Information:
Lot Dimensions
Landscaping
Existing Structures
Proposed Improvements
Drainage Plan
Hydrants
Structure Setbacks
Easements
Topography
Septic System (s)
Lighting
Signage
Water Lines
Sewer Lines
Shorelines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
,
Names of
Fronting Street
Flanking Street ,
DoT= 75X /y5
Fico Air Peopctry