1986, 09-15 Permit App: 00013121 Garage'ez
(THIS IS NOTA PERMIT) -
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
aCOIv1PLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
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Architect/Engineer
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Business Phone
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DEPARTMENTAL REVIEW
1 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
Hold
Environmental Health Application #
is
t/'
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4 is._,
1
4, A.
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
-
-
Other(SEPA/CrItical Material/etc.)
Fast Track/Speclal Inspection Information
Project Representative
.1
Phone
Address.
1 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
kr
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