1986, 05-28 Permit App 00011249 Storage Bldg(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)
SHAULU ANtAS Alit I-0H Utf'Ati I MLIN i AL UJt-
•I.
Pro t Number.
Owner' N e LAST / / FIRST MI
')VO
t'- Kiris f o t D NI/
Project Address (Street Name & Number) Zip
/o s/7 rE-,Ric 1)R
Applican �
�ER Ave ") t.i R i S .�' C-
Address
.
g z90 �4.-A,6-K A.
I
City
.54-✓4./ ,,
State
/AL--/-/o
Zip
g3(tC9 ilt
Phone
( ) 4.2 63- cosC
Business Phone
Contractor / Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State f Zip j
Phone
( )
Describe Work
Res.
Comm_
Subdivision/Plat Name/Short Plat Number
1 L L.eI- f `'1- AAOD1T1r
Assessor Parcel Number
C.5--HI —1 J3
Lot
13
Block
2
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
C.
Number of Buildings
1
Lot Size (Sq. Ft./Acre)
l
Depth
'3 zp t
Frontage
13n f
Front Setback
Left Setback
Right Setback
Rear Setback..... .
R! W Width
Additional Information
I _BUILDING INFORMATION 1
Square Footage
Number of Bedrooms
Group
t )
Type
U ice;
Building Technician
1. . / (�,z
Dater /
" E// ('
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Stricture Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
..1
-�.....
�
I
tit
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Planning/Zoning
] N. 721 Jefferson
Engineers
I N. 811 Jefferson �`--& r 744
S $
Utilities 1
N. 811 Jefferson It
I l
Plan Review/Fire Prevention
1
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 to compile said application is true and correct.
Date