Loading...
1985, 07-03 Permit App: 00006704 Residence(THIS IS NOT A PERMIT) Y59 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) SHADED AREAS ARE FOR DEPARTMENTAL U E S Project Number f Owner's Na LA FIRST MI Project Address (Street Name 8 Number) _ Zip Applicant Address City State Zip Phone Business Phone Contractor/Ag nt Address /� City �n State Zip Phone ( ) -/ Y,43 —� License Number (Required) Business Phone ) Architect/ Engineer Add ress City State Zip Phone Contact Business Phone Lender Address City State ----- Zip_— — Phone Describe Work Res. Comm. Subdivision/ Plat NamelShort Plat Number Assessor Parcel Number Lot Block Plat Number i Pertinent File Numbers Zone Comp. Pian --1 Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./Acre) Depth Frontage --� Front SetbackI Left Setback Right Setback Rear Setback Additional Information Square Footage W (JJ ,. Z W s '* max,}• F- Cr a. W i a Building Technician nate C,rou T i n, 0 o► .•moo { � _ � � (//� � g�� .� � a �., �,.�. 3 g LK -3 lot 00 Y1 '1061 10 k Ho 7T,1 f. DOI- - FE] 0 0 N 0 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 is true, correct, legal, and binding. Owner's Signature ", �/""'— Da �— I Approved Cond. Approval Hold Environmental Health Permit Number W. 1101 College Room 200 ,1 11�11 S'© .,C Planning/Zoning N. 721 Jefferson Engineers Permit NumberNrl��` 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 is true, correct, legal, and binding. Owner's Signature ", �/""'— Da �— I