1985, 10-22 Permit App: 00008300 GarageN
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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.
SignatuLa?� _&"Ake,, Date
(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)
Approved Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200 AAQ
Planning/Zoning
N. 721 Jefferson —
Engineers
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
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.
SignatuLa?� _&"Ake,, Date
(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)
Show on Site Plan: Additional Information:
E a upuauu 1111in uwumunus
nyuranu
Structure
ructure 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
Scale: I
Date:
Revisions: Attachme
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