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1986, 09-10 Permit App: 00013052 Storage Bldg
(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 dm; Owner's Name LAST Yr.F FIRST MI Project Address (Street Name & Number) —c A2D1 Zip Address City State Zip Phone Business Phone ) Contractor/Agent City Cob ir 564 si L 5/e/Is State DTS &ircl74 EIS Contact (elto Architect / Engineer City © 1 State eo ker."k/4 Address Zip 927 License Number (Required) Jig v/i r 27i Phone Business Phone ( ) Contact � j ,, t /"'j'(j11j/. Lender City Address t/47E /- /f74, z; 'al Zip Phone Business Phone ) ‘77.4 Address State 1 Zip Phone Comm. umber of Buildings Lot Size (Sq. Ft./Acre) Right Setback Plat Number Census Tract Depth Frontage Square Footage Number of Bedrooms Group171-'j Type DEPARTMENTAL REVIEW 1 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 CD68rCond. Approved i Approval Hold Environmental Health Application # O��/: W. 1101 College Room 200 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 1 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 I , t B 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 I , t B -7- I , t B