1986, 04-09 Permit App: 00010388 Barn(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Owner's Name
LAST FIRST MI
t Project:Number
Project Address (Street Name 8, Number)
E4s-r /121061 £xrP/RE Avg.
Applicant
agooda
Phone
License Number (Required)
Business Phone
Add ess •
Subdtvis ontRlat Natre&Shgrt
lat'Numberri'
Number of Buildings
ft,Setbac
Lot Size (Sq. Ft./Acre)
Right Setback
RAN Width-��
Type,.
\% hl
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 ."` 9 •/ 9 F6,
Approved
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Plannin /tonin
9 9
N. 721 Jefferson
54.,",6
/"Engineers -�yf� �J
��9
.i i
N. 811 Jefferson 7/ /3 /
il'
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Materlal/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 ."` 9 •/ 9 F6,
is