1987, 01-21 Permit App: 87000150 Carport(THIS IS NOT A 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
Project Number
/5b
Owner's Name LAST FIRST MI
/Yd !.1 6i=ivy es Co
• eject Address (Street Name & Number) Zip
/ = 8
Applicant
Address
City
State
Zip
Phone
Business Phone
/Agent
Contr
Address
it
State40‘044i
Zip
Z U 7
License Number (Required) 1 Business Phone
,i,.(9-11 G -AC 1 S ( )
f 9a l= o� /re
Phone
x'09) 9 z i' - 8G '
Architect /Engineer
icy
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
DEPARTMENTAL REVIEW
I 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
Approved
Cond.
Approval
Hold
" Environmental Health Application #
0/113/81t�c
LV N
�v~
_
w. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
6) Zot vAzy ---Ce-Ateld- — 01-5/ I.I
..5 ' .e-e4..c7a4, 7- /2-7
Engineers
N. Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention .
N. 811 Jefferson
I
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I 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