1985, 11-07 Permit App: 00008598 MH •
DEPARTMENTAL REVIEW
Approved Cond. Hold
Approval
/Environmental
Environmental Health Application# i0
5f
W.1101 College '4D
Room 200
Planning/Zoning
❑ N.721 Jefferson
beEngineers c�•� //
N.811 Jefferson -! Ls l . 1 / //.
i 721. y��..�
Utilities
0 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 to compile said application is true and correct.
Signature OLIA- Date �� ( 2't'5
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