HomeMy WebLinkAbout1985, 07-26 Permit App: 00006575 Garage (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 ARE FOR plans to the Department of Building and Safety)
SHADED AREAS DEPARTMENTAL USE I Project Number
/ Owner's Name F� LAST FIRST MI
Project Address(Street Name&Number)
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Address
Applicant
City State Zip Phone
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Business Phone ( .57?7
(5!` ) 92'
Address
P
Phone
ontractor/Agent Zip
( „..
)State Business Phone
( )City License Number(Required)
Address PhoneIZipArchitect/Engineer State Business Phone
( )City Address
Phone
)(Lender I Zip
x
State „. ' "
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Permit Number J367 Ag W.1101 College f�.,
Room 200
7 24- q
Planning/Zoning
❑ N.721 Jefferson
Engineers Permit Number
❑ 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 is true,correct,legal,and binding.
Owner's Signature Date
. ‘-‘,\
13_14 EMFMT
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E. /9322 VALLEY WAY
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