1985, 10-24 Permit App: 00008877 Storage Bldg (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 plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number . , /' 601.7
Owner's Name LAST FIRST MI
12(N) L
Project Address(Street Name&Number) Zip
Applicant Address
City State Zip Phone
Business Phone
( )
Contractor/Agent Address
City State Zip Phone
Contact License Number(Required) Business Phone
Architect/Engineer Address
City State Zip Phone
Contact Business Phone
( )
Lender Address
City State Zip Phone
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Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number Lot Block Plat Number
Pertinent File NumbersZo Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
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Front Setback - Left Setback Right Setback Rear Setback
Additional information Square Footage
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Building Technician Date Group Type
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Permit Number 44Jrc_z-1rI
W. 1101 College
Room 200 Iop.gi8 S
Planning/Zoning
❑ N.721 Jefferson
•
Permit Number
Engineers
❑ N.811 Jefferson __.
Utilities I
❑ 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
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