1986, 08-26 Permit App: 00012989 Detached Garage(THIS IS N..TA 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
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Owner's Name
Project Address (Street Name & Number)
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Applicant 00e2".
LAST FIRST
City
State
MI
Zip
Z/2-
Addr�-4144.
Zip L' Phone ( ) 92e.
Contractor/Agent
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Business Phone
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Address
City
State
Zip
Phone
Contact
License Number (Required)
Business Phone
Architect/Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
City
State
I Zip
Phone
Block
Comp. Plan
Number of Buildings
Lot Size (Sq. Ft./Acre)
Plat Number
Census Tract
Depth
Rear, Setback.
Frontage
R/W Width
Square Footage
720
Number of Bedrooms
Group Xyffe•
11'1' —\L ti
DEPARTMENTAL REVIEW
-
Approved
Cond.
Approval
Hold
Environmental Health Application #
Rr�
W. 1101 College'c..
Room 200
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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 Date
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (a)
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
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Legal Description
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