1985, 07-26 Permit App 00006593 Residence, Garage(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)
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Project Number
Owner's Name nKLAST FIRST MI
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Project Address (Street Name & Number) �— Zip
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City (
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State
M
Zip
-0 6
Phone
(9 ir) ‘ i 6/
Business Phone
( )
Contractor/Agent
S--L,,L �.e-r (..4
Address
_- ]3 /O I/ f('i ,4) Cd ,
City
State J
Zip
Phone p
Contact
License Number (Required)
Sti1AjL0 1'2 Mp
Business Phone
(9.)y) 49‘/
Architect/Engineer
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Address
44''-Se �1.
ity
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State
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Zip
1 1I es
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
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State /
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Zip
Phone
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Descrbtfe Work ( p
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number
0544 I —►S oZ
Lot
Z.
Block
I
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
I
Number of Buildings
1
Lot Size (Sq. Ft./Acre)
Depth
2 73
Frontage
144
'
Front Setback I
35
Left Setback i
-3
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Right Setback
3 I t
Rear Setback
Additional information
DEPARTMENT USE
Square Footage
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2 = 3 3 a
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Building Technician
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Date
'7/u/8 "
GroupType
R 3
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DEPARTMENTAL REVIEW
Approved
CpApproval
Hold
Environmental Health Permit Number b —0OW
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W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
Permit Number
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Engineers
N.811 Jefferson
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Utilities
N. 811 Jefferson
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Plan Review/Fire Prevention ' �DC./t
N.811 Jefferson _ _NIJOi � ?
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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 Date
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