1985, 10-02 Permit App: 00007812 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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Ow er's Name LAST
Project Address (Street me & Number)
FIRST
Gni YZ,V�/
MI
Vg So
6 C,4 C$ S'7"-: SP1 ' G�r�
Applicant
G 7-7Y12y
City State
Zip
4e?;1/ 2
Zip
syr
fr? o
Phone
Business Phone
Contractor/Agent
Address
City State Zip Phone
.Po,/z/eff x-23
Contact License Number (Required)
Architect /Engineer
Address
State
Contact
Lender
Phone
Business Phone
Address
State Zip
Phone
(
tlnent FD N
Addittonat In
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 t'le said application is true and correct.
Signature
Date fO
Approved
pp
Apprrovov al
Hold
7 Environmental Health Application #
-
9
y
10-1—(617
W. 1101 College
Room 200
Planning/Zoning ` rE. .7 `, / _ e5
N. 721 Jefferson V �
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
. Plan Review/Fire Prevention
N. 811 Jefferson
—
/�jifl/
11
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 t'le said application is true and correct.
Signature
Date fO
s e A.' • 4,!s- -te
1