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1986, 06-16 Permit App: 00011602 Garage (`rHIS 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 �Projeot Number //�%�CJv Owner's Name LAST • FIRST MI i • ;ti's( #e� r lit Project Address t Na.me&Number) ! Zip -s, j.3o '/ .S kip �o r `19x06 Applicant Address Pierre/• 1 e'City �� r Pha©1/ �I( IAV p 1)5 Kot �� Business Pto e hony) A,4/...2.4 /... _� '7 Contractor/Agent Address City State IL pPhone_ ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender v Address City State _'i p Phone l +�168iNork "t Res. / Comm. n y. TACI4 E (9�4 (2(0)(3O) . '' /Plat ame! Ptat Number 'Assessorparcel,Number Lot Block Plat Number 2_/51/3— /3�2 2— Pertinent File Numbers Zone Comp.Plan Census Tract NumberDwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth�+ Frontage � �� . ; I, Z l558 l gntSetback Left Setback Right Setback Rear Setback R/W Width �1 2-' Additional Information Square Footage s.. Z 0 Q cc � 0 IA. ;, ,` z �„; C7 -, ems 2_ J m Number of Bedrooms �� v v z t '. ildingTechnician Date Group Type NJ lo- /�— M—t V DEPARTMENTAL REVIEW Approved Cond. Hold Approval Environmental Health Application# W.1101 College Room 200 J �� Planning/Zoning ❑ N.721 Jefferson Engineers ❑ N.811 Jefferson Utilities 0 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. 111 Signature fArc Date 6-16-Z6 'J /•-• it,i,:,•• I , • !,.,.....-... • ,c ,1 I 1 f I f t T , • . t : I I ' 1 I 1 - .•' it.,,• i,, ,,,,.. .•, i ...-..._(1._..,,....,, ,,.. .• ,,,, • ,t,,,•t _......t.,.._ ,t,t • ,,.•,. --., - t 7I••t'. 7,., " -1- ---1 . ..,. .. , . . I .., 1 ,' \ ..,• ,; i „. ._ , , ; I 1 , .".XIFF i f . ,--- i ., ; ..,; ,...,...., .,,,, i t „ , . , „....., -,.- ,, ., .... ___....... , _, . , • . , , . , • ., • I• 1 • . ,`,$ I I- I:" , , , I i . ' i 1 1. I 5.... .,......., j1 1 I I I 1 , i 1 , t I ' -+- , . I .'"'" * 1 f• , I 3 . , , . _.1... 1 . : I t . r 1 i I 1 • 1 . 3 - . : , 1 • 1 , • • ilk 1 I i : 1 i . . 1 . . 7- ' , t_. . ...,,,,,...„..........................„.....,...,...__..4„..,..,.,.....„.......---.......k., , - 1 ' i ' . I 4 I ', 1 _•• 1 1 , , , I I 1 , i I 1 ' I , , . ! i 1 , . . .• ..,_ 1 , , . , . , 1,1 . . I J 1, , A 1 :. , i 1 : ... . 1 , i . , 1 I I , • I • ,. 1 i 1 , t, + . • • . ,' . , . . • , . 1 • r ' 1 l. 1 , , -.....-L.--.7... ...._. .....7. ._4___ i 4 - ` il - •- '-t-- •"•• • t`- 1 --t • • • 1 I _ 1 . • -,- .. . . , , • . .