1987, 11-02 Permit App: 87003737 Siding, Eaves, Shutters (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) //// ✓!\
i /,.,r") SHADED AREAS ARE FOR DEPARTMENTAL USE
' folect Number
Owner's Name LAST FIRST MI
Project Address(Street Name&Number) Zip
/46/22 • W11 1 eAfCL dale) q?C 7
Applicant Address
r41-cellt6j1 Se/;/
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City State Zip Phone
Business Phone
( / ) S35--L//C1
Contractor/Agent- Address
City 1 State Zip Phone
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Contact License Number(Required) Business Phone
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Architect/
Architect)Engines Address
City State Zip Phone
Contact Business Phone
Lender Address
City State Zip Phone
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Describe Work Res. Comm.
Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number Lot t Block Plat Number
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Pertinent File Numbers Zone
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Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front Setback Left Setback Right Setback Rear Setback RIW Width
Additional Information Square Footage
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0
1-
2
cc
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2
2
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5
co Number of Bedrooms
Building Technician Date Group Type
Show on Site Plan: Additional Information:
Lot Dimensions Landscaping (
Existing Structures Drainage Plan — I I
Proposed Improvements Hydrants r ( I
Structure Setbacks Topography I
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Easements Lighting — — — + — — —
Septic System(s) Signage — _ I
Water Lines Shorelines I �-
Sewer Lines Highwater Mark --~ — j 1 I _
Fences,Wells i 1
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Driveway(s) j !
Right of Way Width(s) — + {
Names of ! i I
Fronting Street ---1t —
Flanking Street j
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Legal Description T-
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Scale:
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Date:
Revisions: Attachments:
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