1986, 02-03 Permit App: 00009590 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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Numberof Dwelling Units
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Additional Information
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(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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Rear Setback
R/W Width
Additional Information
1 BUILDING INFORMATION
Square Footage
Number of.Bedrooms
Building Technician
Date
Group
Type
❑'
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.
Signatur
Date 2."-F - v
Approved
Cond.
Approval
Hold
Environmental Health ApplicationM i
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♦
W. 01 College
*Room 200 ,
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
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Plan Review/Fire Prevention
N. 811 Jefferson
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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.
Signatur
Date 2."-F - v
DEPARTMENTALREVIEW
( •
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
•
Approved
Cond.
Approval......1--1
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Environmental Health Application
W. 1101 College .
Room 200 ' ' •
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Fast Track/Special Inspection Information
Project Representative
Phone
Address
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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
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