1985, 11-15 Permit App: 00008731 GarageShow on Site Plan:
Additional Information:
Lot Dimensions
Landscaping
Existing Structures
Drainage Plan
Proposed Improvements
Hydrants
Structure 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
I Descri
Scale:
Date:
Revisions: Attachments:
1 -1
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FOA
DEPARTMENTAL REVIEW
_
Approved
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
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Project Address (Street Name & Number) Zip
9el-03 -7
Applicant
Planning/Zoning
N. 721 Jefferson
City
State
Zip
Phone
Engineers
N. 811 Jefferson
Business Phone
Contractor/ Agent
Address
�-hd1,2116
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Utilities
N. 811 Jefferson
City
State
Zip
Plan Review/ Fire Prevention.
N. 811 Jefferson
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Other (SEPA/Critical Material/etc.)
Number (Required)
Business Phone
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.
Signature - - Date [ �'
(THIS IS NOTA 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)
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Project Number
Owner's Name LAST FIRST MI
no—— rE!
Project Address (Street Name & Number) Zip
9el-03 -7
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor/ Agent
Address
�-hd1,2116
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City
State
Zip
Phone
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Contact ILicense
Number (Required)
Business Phone
LS
4-0Z 7
Architect/ Engineer 1
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
Describe Work
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Res.
Subdivision/ Name/Short Plat Number
roPT 400
Assessor Parcel Number Lot
Block
Plat Number
235 V1 - 300:2-
2 -
Pertinent
Pertinent File Numbers
Zone,
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. FtJAcre)
DepthFrontage
/
12-5
q5
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
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Additional Information
Square Footage
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Number of Bedrooms
Building Thni�
Date
Group
Type
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