1985, 09-17 Permit App: 00007500 Garage X (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
I Project Number
Owner's Name LAST FIRST MI
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Project Address(Street Name Zip
8 Number) ` • '
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Applicant Address
City State Zip Phone
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'- Business Phone
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Contractor/Agent IN/ f p ��� Address
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City State Zip Phone
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Contact License Number(Required) Business Phone
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Architect/Engineer Address
City ' State I Zip Phone
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Contact Business Phone
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Lender Address
City State l Zip Phone
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Describe Work Res. Comm.
Subdivision/Piq Name/Short Plat Number -
Assessor Parcel Number Lot Block Plat Number
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Pertinent File Numbers Zoned Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front t i Left Setback fr t Right Setback Rear Setback
Additional Information Square Footage
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