1986, 09-02 Permit App: 00013128 Storage Bldg(THIS IS VOTA 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)
X05
SHADED AREAS ARE FOR DEPARTMENTAL USE
1
ect Number 24413
Owner's Name
LAST,
Project Address (Street Name & Number)
F
FIRST
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Applicant
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Address
City
1
State
Lt2 s
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Phone
(5 7) 2 -76 7
Business Phone
( so) j 2 cf 727 (
Contractor/Agent
Address
City
State
Zip
Phone
Contact
License Number (Required)
Business Phone
( )
Architect I Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
ParcetN
o SA Z KI
25i/I_0303
Lot
Block
Res
Plat Number
Comm.,
fe Numbers
Zone
�15
Comp. Plan
Census Tract
Of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft.l Acre)
Depth
Frontage
Left Setback
Right Setback
Rear Setback
R/W Width
Itionai Information
ng Technician
Date
NFORMATION
z
J_
D
Square Footage
Number of Bedrooms
Group
Type
DEPARTMENTAL REVIEW
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Approv
Cond.I
APProval
Hold
Environmental Health Application #
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W. 1101 College
Room 200
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/ Planning/Zoning
N. 721 Jefferson
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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
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