1986, 03-25 Permit App: 00010181 Garage(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OFTHE 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
LAST
tg
Project Address (Street Name &Number)
Applicant
FIRST
MI
Project Number
g 6 2 L t Yrs Logazo
Add
ess
NJCB C
Phone
( 9 534 43c4—
Business Phone
( 1
Contractor/Agent
Ck C: C or tiro c4or5
State
Contact
Zip
Address
Phone
Architect /Engineer
City
Contact
Lender
City
Address
State
Phone
Business Phone
Address
State
Phone
at Number
Zone
ber of Bufidi
tie
Lot Size (Sq. Ft./Acre)
Comp. PTan°"
`Census Tract
Depth
Frontage
DEPARTMENTAL'REVIEW '
/7
Approved
Cond.
Approval
Hold
/ Environmental Health
W. 1101 College
Room 200
Application # et -o/
3 /
i. _
I
—: Ow
/ S
i , .
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other(SEPA/Critkal 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
1 OfL
Date 1 /,
Legal Description
E 70Fr- of N ��5 o F l2
&Cor & )ec, N 20Fr
Scale:
Date:
Revisions:
Attachments:
l
Show on Site Plan:
Additional Information:
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
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
E 70Fr- of N ��5 o F l2
&Cor & )ec, N 20Fr
Scale:
Date:
Revisions:
Attachments:
l
N rLOT PLk 72..
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