1986, 10-08 Permit App: 00013530 Carport(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
I Project Number /g530
0
Owner's Name LAST FIRST
7
Project Address (Street Name & Number)
MI
Zts
Zip
72l_Z > 6-1R4 CT"
Applicant
&1►f0177(,-40"2476 rilCte 311
Address
CityJ / le/ � State
e
Zip
11
Phone
( -Y) ! 1,5 cl'J
Business Phone
Contractor/Agent
FLL
Address
PO0 d �
City
Contact
Architect/Engineer
State
Zip
Sem
License Number (Required)
Phone
Business Phone
( )
Address
City
State
Zip
Phone
Contact
Business Phone
(
Lender
Address
City
State
1 Zip
Phone
Res.
Comm.
Plat Number
Lot Size (Sq. Ft./Acre)
oCO
Right Setback
Comp. Plan
Depth
Census Tract
Frontage
R/W Width
Squar_e.Footage
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 • mpile said application is true and correct.
Signature
itc3y--
Dateate
Approved
CpApproval
Hold
/ Environmental Health Application #
S 076
,A
/0, d d v
W. 1101 College(,
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
I
I
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect 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 • mpile said application is true and correct.
Signature
itc3y--
Dateate