1985, 09-12 Permit App: 00007421 Deck, Ramp(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)
JMAUtU At-ttAJ AKt t'UK UtYAK 1 M tN I AL UJt
I Project Number
Owner's Name LAST FIRST MI
V ANDER. LINDEN Lois P•
Project Address (Street Name & Number) Zip
S. 7/ /nAmER /Z D. 3Pokl1NE 1 wA. ` ZJ6
Applicant
SAME-
AflCity
Address
City
State
Zip
Phone
Business Phone
(
Contractor/Agent
Add
ess
City
State
Zip
Phone
1
Contact
License Number (Required)
Business Phone
I )
Architect/Engineer
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
( I
Lender
I Add ess
City
Slate
Zip
Phone
I
Describe Work
Rea.
Comm.
Subdtvision /Plat Name / Short Plat Number
A.ase- aor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Pian
Census Tract
Number of Owelttng Units
Number of Buildings
Lot Size (Sq. Pt./Acro)
Depth
Frontage .
Front Setback
Left Setback
Right Setback
Rear Setback
Additional information
r DEPARTMENT USE
Square Footage
•
9
Building Technician
,J U 1Vi r
Date 1/
L ? ' �" ;"
1
Group
'
Type _ .:
., I.\.;
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
O W. 1101 College
Room 200
Permit Number
Planning/Zoning
O N. 721 Jefferson
Engineers
O N.811 Jefferson
Permit Number
Utilities
O N.811 Jefferson
0
Plan Review/Fire Prevention
N. 811 Jefferson
T
mss
DF-cr AND RAMPCoMSYRU1cTIoN /S SURJCCT To FIELD INSPFCD0NICPIscUSED t4n-rH ARTEWdcSot./
tel,/2/83)
Other (SEPA/Critical Material/etc.)
Fast Track /Special Inspection Information
Project Representative
Phone
Address
1 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
/3_
p 1 0 o a m B O
N1;14111('/ r 33"
.2, m- m—/oox.
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