1986, 05-06 Permit App: 00010882 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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DEPARTMENTAL REVIEW
I certify that 1 have a amined this application nd state that the Information contained in it and submitted
by me or my agent Compile said application true and correct.
/
Signature
Date ` - ` - U v
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Approved
Ad.
pproval
Hold
Environmental Health Application k
W. 1101 College
Room 200
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Planning/Zoning -
N. 721 Jefferson
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N. 811 Jefferson 4
Utilities
N. 811 Jefferson
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Plan Review/Flre Prevention
N.811 Jefferson _ - _._
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Other (SEPA/CrItIcal Material/etc.)
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Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that 1 have a amined this application nd state that the Information contained in it and submitted
by me or my agent Compile said application true and correct.
/
Signature
Date ` - ` - U v
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 Deicription
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Attachments:
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