1985, 10-23 Permit App 00008254 MH�► 4
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Permit Number gc." 1073
• W. 1101 College
Room 200 ,0/13l
Planning/Zoning e — 8S — 36 4
N. 721 Jefferson
Permit Number
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N. 811 Jefferson Z�'—,qS— 3 6D� /2O
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Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
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 SignaturePZee-ii.."' (2,,tle44.-L_
Date
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