1986, 03-27 Permit App 00010211 BarnDEPARTMENTAL REVIEW
/
LQL_".17
Approved
Cond.
Approval
Hotd
Environmental Health Application # el
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Matedal/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 to9opplie said application is true and correct.
7
Signature
Date
(THIS IS NOT A 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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number
03ntractor/Agen
rn
City,
Contac
LAST FIRST MI
State
COV,,
#,VNe.,74.1.YAVZ
Zip
License Number (Required)
Address
Phone
Business Phone
Address
Phone
Business Phone
Address
Business Phone
Address
Zip
Bedrooms
- .
'Vat:
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
Scale:
Date:
Revisions:
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Attachments: