1985, 08-22 Permit App: 00007063 Roof Cover(THIS IS NOTA PERMIT)
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)
DEPARTMENTAL REVIEW
Owner's
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.
Date 6 _
Signature
Approved Cond.
Approval
Hold
o /
Environmental Health Permit Number p' r
W. 1101 College
Room 200
❑
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
Owner's
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.
Date 6 _
Signature