1986, 10-01 Permit App: 00013308 Shop(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
FIRST MI
1
Phone
Business Phone
(
Zip
Contractor/Agent
Address
State
Architect/ Engineer
Phone
Business Phone
Address
State
Lender
City State
Phone
Business Phone
Address
Zip Phone
Lot Size (Sq. Ft./Acre)
Frontage
Group
Type
DEPARTMENTAL REVIEW
,v
Approved
nd.
Approval
Approval
Hold
/�!`'�
Environmental Health Application # / � /i
-
W. 1101 College
Room 200 _A,
• / —
.
_
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
�.VP
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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.
Signatur
Date
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DATE:
IAPPROVED SY:
DRAWN SY
REVISED
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