UniversityS 414 University Manor - Add Storage & Laundry
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BUILDiNG PERMIT APPLiCATION WORKSHEET
PI.EASE PRiNT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN INK
(Please return this onginai and your building.plans to the Oepartment of Buildiny aricl Safetyl
SHADED AHEAS ARE FOR DEPARTMENTAL USE '
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DEPARTMENTAL REVIEW -
Cond
Approved Approval FiOId
Environmente) Nealth Perrnit Number
W. 1101 Coltege
Room 200 -
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Planning/Zoning
N 121 Je(terson /
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Engineers Permit.Number
~ N. 811 Jefferson
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Fast Track/Speclal Inspection Informatlon
Project Representative Phone
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I certify that I havE P.xdmined ihiS dQpl+Cation and state ihat the information contained in it and submitted
by me or my aGer:t is true, correct, leaal, an,y binding
Owner s Signatuie n~tp
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SIGNATURE OF APPLICATION
~ PWNV OR AGENT , DATE
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