HomeMy WebLinkAboutMission E 12012 Remodel for Psychiatrist Offices
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(THIS IS NOTA PERMIT) ~
BUILDING PERMIT APPLICAI'ION WORKSHEET
PLEASE PRINT AND C4MPLETE ONLY TH4SE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN INK
(Please return this arlglnal and your building plans to the Oepartment of Building and Safety)
SHAOED AREAS ARE FOR OEPARTMENTAL USE
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DEPARTMENTAL RE1/IEW
Approved A p Cand oval Hoid ~
Envlronmentef HeaNA Appltcation q ' I
~ ,W.110t Collepe
~ Aoom 200 ~
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Ptanning/Zoning ' . _
N.721 JeNerson '
~ Engineers
N.811 Jetferson
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uunties
, N 811 JeNerson
Pian Review/Flra Preventlon '
❑ N. 811 Jefferson -
Oiher (SEPA►/Crltlcet Msteriel/ete.) ~
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❑ FeetTradc/Spselal inepectlon Intormatlon
Project Representatfve - PAons
Addroa
I csrtify that I have exemined thls application end atete that the infotmatian contatned in It and submitted
by me,or mr agent to compile said appllcatlon ia true and correet "
Stgnature - - - Date