1986, 05-06 Permit App: 00010852 Barn(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)
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Project Number
Owner's Name LAST FIRST MI
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oject Address (Street Name & Number) Zip
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
( )
Contractor/ Agent
Address
City
State
Zip
Phone
( )
Contact
License- Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender y
Address
City
State
Zip Phone
( )
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ibeWorkRes.
Comm.
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Assessor Parcel Number.. ;.
Lot
Block
Plat Number
Perone t File Numbers s
Zone
Comp. Plan
Census Tract
Nun Dwelling Units ; ...
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Left Setback
Right Setback
Rear Setback
R/ W Width
ddititJ l Information
BUILDING INFORMATION
Square Footage
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Number of Bedrooms
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Group Type
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 compile said application Is true and correct.
Date -��-/X
Approved
Cond.
Approval
Hold
Environmental Health Application #CD
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W.1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
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 compile said application Is true and correct.
Date -��-/X
Legal Description
Scale:
Date:
Revisions: Attachments:
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Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
Landscaping
Drainage Plan
Hydrants
Structure Setbacks
Topography
Easements
Lighting
Septic System (s)
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
Scale:
Date:
Revisions: Attachments:
.?- 9 ':
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Scale:
Date:
Revisions: Attachments:
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