1985, 09-12 Permit App 00007418 Carport(THIS IS NOT A 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 AlitAJ Atit rUti UtYAti I IVILN I AL VOL
I Project Number
Owner's Name �1.AST FIRST MI
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Project Address (Street Name & Number) ` Zip
Applicant
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Address
/3 '? G`- 6y4
Cit
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State
6609»Y
Zip
772 /
Phone
(sb 7) 72 C fc
Business Phone
( ,_ )
Contractor/Agent � !�
mil/
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect lEngineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
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Describe Work
Res. .
Comm.
Subdlvlslon/Plat Name/Short Plat Number
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Assessor Parcel Number
Lot
Block
Plat Number
PertinentFile
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Zone
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Comp. Plan `
Census Tract
Number of Dwelling Units
-
Number of Buildings
`%
Lot Size (Sq. Ft./Acre)
Depth
'__.
Frontage
L
Front Setback
Left Setback '
Right Setback .
Rear Setback
Additional Information
DEPARTMENT USE
Square Footage
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DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
W. 1101 College
Room 200
Planning/Zoning /�7 _ C�
N. 721 Jefferson VC'`�t` Cs Nrov-'�1 N4-{c CJf kA)V-4t -6j(1
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7
Permit Number
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
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 Signature -
Date' (2