1985, 10-29 Permit App: 00008390 Addition(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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....Owner's
Project Number
Name LAST LAST FIRSTyyMI
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Project Address (Street Name & Number)/ Zip
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Applicant
Address
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City
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State
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Phone
Phone
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Business Phone
Contractor/Agent/
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City
State
Zip
Phone
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License Number (Required)
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Business Phone
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Architect/ Engineer
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Address
City
State
Zip
Phone
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Contact
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Business Phone
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Lender
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—City
Address
City
State
Zip
Phone
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Res.
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Subdivision /Plat Name/ Short Plat Number
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Assessor Parcel Number
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Lot
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Block
2
Plat Number
Pertinent File Numbers
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iLLoott/Siiizzee
Comp Plan
Census Tract
Number of Dwelling Units
/
Number of Buildings
/
(Sq. Ft./Acre)
Depth
Frontage
Front Setback
EI(ST/ /v($
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
Square Footage
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Number of Bedrooms
Building Technician
G
Date
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Group
C2-2-
Type
V N
L.
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application #
Approved
Cond.
pproval
Hold
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/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 to compile said application is true and correct.
Signature
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