1985, 03-12 Permit App: 00004438 Residencer y' BUILDING PERMJT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your bu l Id Ing plana to the Department of Building and Safely)
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DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indlcate above or attach reasons for hold
on Type
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apace prior toPermitissuance.) conditions-
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❑ Commercial; ❑ Residential
VNew Construction; ❑ Bldg alteration/ addition
❑ Additional structure;
APPLICATION #
Coadl�onsIgili m stus:
5;�4 Al -!5'
❑
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; ❑ Cart, of Exemption; ❑ Frontage;
❑ Setbacks; El lot w/d; ❑ lot size; ❑ usefzone;
❑ CU, variance, zone change; shoreline; ❑ farce;
❑ Other
Comiltions/ Comments:
Engineers:
N. 811 Jefferson
❑ Commercial; ❑ Residential; ❑ Flood Plein;
❑ drainage %Y'rewaccess/approach; ❑ fence;
Conditions/Comments:
❑ road Improvements
❑
Utilities:
N. 811 Jefferson
Conditions/ Comments:
❑
OMar:
❑
Plan Exam
Fire Prov.
Conditions/ Comments:
El
Project Representative
Telephone
Agencies Performing Special Inspection:
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1 Indicate above or attach conditions relative to final as built approval
2 Indlcate above or attach reasons for hold
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