1986, 10-21 Permit App 00013756 Re-Side(THIS IS NOT A PERMIT)
• BUILDING PERMIT APPLICATION WORK$HEET
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 ad Safety)
• SHADED AREAS ARE FOR DEPARTMENTAL USE
Owner's Name
oject Address (Street Name & Number)
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Applicant
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State
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Zip
License Number (Required)
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Zip
Business Phone
Address
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Business Phone
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Address
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DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
W. 1101 College
Room 200
Application #
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPALCritical Materlal/etc.)