HomeMy WebLinkAbout1984, 05-23 Permit App: 00000339 Sun PorchBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
(last) (first) (m) Department Use Only
1 Owner's Name,,
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lA e //in Cz _� 8 �(_ At e /� L -e tei • Res.
I
Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
1 110 FA/ Lpit 0 fK,0-
3 City/Community
Crzell eWe
State
(,)all
Subdivision/Plat Name
Ga � "� i vuOM
4 Ass��es??so/r Parcel No. '7 j
c I
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
F
Project No.
6 Dwell#
1
No. of Buildings
1
Sq. Ft./Acre
Depth )
Frontage I
lie
7 Set Back -Front
t_`7I�
(L S-1
� �ij1--
(R)S 2
#
0 0 I
Rear
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E/t
Census Tract
"
Module No.
Initials
JLK) fr .
16 Architect Firm Name
5 elft
Street Address
1 `fef is/ i- ail c
Zip City
q 5 6/ t "C::±eeAeglc[i'eS
State
t..9At 5/i,-
Phone
(Cc f) 7,2cl - Sol
Cent person
/j�
Phone If different than above
Contractor Firm Name
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Street Address
Zip
City
State
Phone
( )
Contact Person t
License No.
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
4
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (YIN) ISEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
IX, Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
10 Applicant Name
!a by - S,` JZ Tun Pi r ch -
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
,
Additional Information
I
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Con ions mments:
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑Frnt age;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
❑ Commercial;
❑ New Construction;
7. Additional structure;
❑ Residential
O Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
/
Conditions/Comments.
O Other
d
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/Comments.
ti
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
Plan Exam
Fire Prev.
Conditions/Comments.
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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