1986, 04-07 Permit App: 00010351 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)
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Project Number I O -3 S^
Owner's Name LAST FIRST MI
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Project Addr (Street Name Number) Zip
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Applicant I
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Address
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City /
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State
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Zip /
91-2/,
Phone
) cam. y77/
/
Business Phone
( )
Contractor/Agent
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 Zip
Phone
(
Describe Work ,r��77 J
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers .
ZoneG,c4)
Comp. Plan
Census Tract
Number of Dwelling
Units
Number of Buildings
2.
Lot Size (Sq. Ft./Acre)
Depth
I
l
Frontage
Front Setback t
Left Setback
Right Setback_ )
Rear Setback
R/ W dth
Additional Information
IBUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Tech ician
Date
Group
Type
DEPARTMENTAL REVIEW
V
Approved
pp
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
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4
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
r
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
1 certify that 1 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
-4:
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