1986, 11-20 Permit App: 00014298 Additions
(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)
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Legal Description
Scale.
Date:
Revisions Attachments:
7 L
Show on Site Pian:
Additional Information:
Lot Dimensions
Landscaping
Existing Structures
Drainage Plan
Proposed Improvements
Hydrants
Structure Setbacks
Topography
Easements
Lighting
Septic System (s)
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
Scale.
Date:
Revisions Attachments:
7 L
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DEPARTMENTAL REVIEW
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.
Signature
Date
Approved
Cond.
Approval
Hold
Environmental Health Application #
717y
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W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
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IN. ell Jefferson
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Plan Review/Fire Prevention
N. 811 Jefferson
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Other (SEPA/Critical Materlal/etc.)
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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.
Signature
Date