1987, 09-26 Permit App 00013316 MH for Storage(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)
Project Number /3 /
Owner's Name / LAST FIRST MI
Cel e-J.^c!2-�I.(--)e .--✓Qy�/x-)
Project Address�ss(Street Name & Number) / Zip /'
!Z 7 7 Ci /a.j4 6,- "e"� 'S�% /S6Qc _— '
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
Contractor/Agent
`57C_-%^%7 e
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
-SQ,n e
Address
City
State
I Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
( )
Describe Work
7t> A TLD (O X5s)
Res. /
Comm.
Subdivision/Plat Name/Short Plat Number
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
�n
i'lh'ic i
Comp. Plan
Census Tract
Number of Dwelling Units
Number of puildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
BUILDING INFORMATION I
Square Footage
Number of Bedrooms
Building Techhnnicciian�
Date
Group
Type
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application #
2.=-4W.1101
�--�
CollegeRoom 200 "k-'
--7---7---
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Materlal/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that 1 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.
Show noSite Plan:
Lot Dimensions
Existing Structures
Proposed improvements
Structure Setbacks
Easements
septic system (s)
Water Lines
Sewer Lines
Fences, Wells
night Of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
8ignoye
Shorelines
Highwo1aryNurh
Le -al [)escription
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