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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Plesse return this oripinal and your buildin8 plans to the Depertment ot Buliding and Safety)
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• DEPARTIVIENT APPROVALS
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~ This is not a Permit '
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(Standard unless (Indicated approvals required In either •release' or •release with conditions'
othen+viae indicated) 9pace prior to pe►mit issuance
Fast Track
Esrly StaR Retease wlcond t Hold 2
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Environmental Health O, Commerciaf; ` iL7 Restdential
W 1101 College p New Constructlon, i! Bidg alterationiadditton
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APPLtCAT10N p
CondltionslComments - - Of
❑ Ptanning/2oning• 0 Commerctal. C Cert at Exemptian, O Frontage. ,
N 721 Jefferson O Setbacks. Q tot wld; 0 lot size, O use/tone,
' 'D CU, variance. zone change, shorellne; O fence,
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Conditi'ans/Comments 2 l> t,N~ tv i4-T I'~
E~ineero.• D Commercial, C r-zc~ S~
- _ 1 ❑ Reaidential. Q Flood Plafn.
~ N 81t Jefferson E] drainage O new,accessiappraach, Q fence,
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Q road improvements
Condlttons/Comments - fla 'o
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N 811 Jefferson .
CondiflonslComments
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: BUILDING PERMIT APPLICATION WORKSHEET
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PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Piease return this original and your bulfding ptans to the Department of 8uilding and Satety)
1 `e Natne ~ (last) (flrot) (m) Dap~Mment UeeOnly
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Adaittmal Informato► Pkfl A/
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i ~ DEPARTNIENT APPROVALS
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This is not a Permit
Applfcatlon Type
(Standard unless (Irtdicated appravals required in etther Iretease' or 'release with condltions°
olherwise,{ndlcated) apaoerprior to permit issvance')
• Fast Treck aelease
❑ WY Start Release w/cond 1, Hold 2
❑ # - - -
Environmentai HeaIth p Commercial. aesident(al
W 1101 College p New Constructton. p 81dg alteration /addition Room 200 O Additianal structure,
APPLICATION q
Condttions/Comments - -
~ - - • ,
Planning/Zontng: 0 Commercial. ❑ Cert o! Exemptton. II Frontage,
N 721 Jefterson O Setbacks: O lat wld. 0 lot stie. CI use/zone, ~
Q CU, varianr.e, zone change, shorelfne, D tertce.
❑ OtNer Condltion /Comments - Ke;t- ~ Al I r t~~ -e~40- oc.~~✓ .
0 Engineero O Cflmmerciat, 0 fiesidential, Q Flood Piain. ~
N 811 Jefierson 0 drainage O new access/approach, Q fence, .0 road lmprovements
Condit(ons/Comments 51&A1 lr'r T• FA. !'-<'ll~ ~ /tilc- Cct;WrW cr/
~ Utilifles:
N 811 Jetferson
Conditicns/Comments, - - - ~ otner- - - ~
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. Conditions/Comments _
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- Project Representatlve - Telephone
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Agencles Performirig,Special Inspection
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