1986, 08-08 Permit App 00012542 Woodshed(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 / 1 1
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Owner's Name LAST FIRST MI
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Project Address (Street Name & Number) Zip
)(32/; i-,x ! I Ga 35'
Applicant
Address
City /�
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State
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Zip
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Phone•
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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 I
Zip
jl
Phone
Describe Work -
LQ'ODD S 61E.0 (t2_X /6y)
Res.
—
Comm.
Subdivision/PlatName/Short a Number
_
Assessor Parcel Number
Lot .
Block
Plat Number
Pertinent File Numbers
Zone A
S
Comp. Plan
.Census Tract .- _AV
Number of Dwelling Units
r
Number of Buildings
3
Lot Size (Sq. Ft.JAcre) ,
t,,5t
Depth
Frontage-
_ , ..
Front Setback
Left Setback
Right Setback
Rear Setback
Additional Information
I DEPARTMENT USE
Square Footage
Building Technician
Date
Grou
T
hb1' If
t n
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
' Environmental
W. 1101
Room
,OF
Health Permit Number
V•reV_
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College
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Planning/Zoning
N. 721
Jefferson
Engineers
N. 811
Permit Number
Jefferson
Utilities
N. 811
Jefferson
Plan Review/Fire
N. 811
Prevention
Jefferson
Other (SEPA/Crltical 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