1985, 10-03 Permit App: 00007829 Storage Bldg(THIS IS NOT A 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
Owner's Name
•
4
LAST
FIRST
MI
Project Address (Street Name & Number)
O4,
-r
Zip
Applicant
V R
BM=9,20
Address
Zip
Contractor/Agent
CO401
1
Phone
)
Business Phone
( )
Address
Contact
Architect /Engineer
License Number (Required)
City
State
Phone
(?2,$:) G
Business Phone
( )
Address
Phone
Contact
Lender
City
State
Zip
Business Phone
( )
Address
Phone
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.
Signature Date
Approved
pp
Apprrovov al
Hold
Environmental Health Application #
W. 1101 College
Room 200
E l.0 6-/2.
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
/lan 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 Date
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
L L P
.. __.._
4