1985, 09-12 Permit App: 00007414 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
Project Number
11
Owner's Name kAST FIRST MI
(74/F/YS T /tl-5.
Project Address (Street Name & Number) Zip
g7'3 5 . /4 /rV A J ' Q'4�6,-
Applicant
/7D/i"/41s J-fl4 a
Address
t r/ (ye 2( I/33e3
City
S-'Q/%f17A/f
State
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Zip
97 /2
Phone
( ) � a (Ss3
Business Phone
Contractor /Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect / Engineer
Address
City 1 State
Zip
Phone
( I
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
i 1
Describe Work , gC
Lr! A--11 \ - (-1 x r3 2
Res.
Comm.
Subdivision/Plat Name/ Short Plat Number _
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone /;t
rr ,�
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
E (
` _
Frontage
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Front Setback ,
Left Setbackr_ i
1
Right Setback
Rear Setback
Additional Information
'ENT USE
Square Footage
DEPART
Group
- i
Type
�� i\j
Building Technician
JUN `m
date
% 2�8�"
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
i
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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 is true, correct, legal, and binding.
Owner's Signature - Date
Approv
•
Cond.
Approval
Hold
Environmental Health Permit Number
ii1'
W. 1101 College
Room 20
i
i
;1
Planning/Zoning
N. 721 Jefferson
Permit Number
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 is true, correct, legal, and binding.
Owner's Signature - Date
1
T
•
T 1
= —1 - '