1985, 08-20 Permit App: 00006999 Garage(THIS IS NOT A 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 �' 5G Q
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Owner's Name LAST FIRST MI
Project Address (Street Name & Number) Zip
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Applicant
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Address
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City
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State
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Zip
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Phone
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Business Phone
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Contractor/Agent
Add ess
City
State
Zip
Phone
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Contact
License Number (Required)
Business Phone
( 1
Architect/Engineer
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
( 1
Lender
Add ess
City
State
Zip
Phone
1 1
ribs Work
Res.
-ems
Comm.
Subdivision!Ptat Name/Short Plat Number
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
u
Lot Size (Sq. Ft./Acre)
Depth ,
Frontage
Front Setpack .
.Left Setback .
Right Setback
Rear Setback
Additional Information
DEPARTMENT USE
Square Footage
'Building Technician Date;
N i',1i i 'r�
Group
Type
1
Environmental Health
0 W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number
Approved
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
Utilities
❑ N.811 Jefferson
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 a.:. t is true, correct, legal, and binding.
Owner's Signature
Date
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PRoPERTy
PRcecDSED
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