HomeMy WebLinkAbout1985, 12-09 Permit Application: 00009052 MH Placement(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)
51-IAUtU AMtAS Al -It I-011 UtF'All 1 M tN 1 AL USt
(project Number 1)52.
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Owner's Name LAST FIRST MI
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Project Address (Street Name S Nu r) Zips
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Applicant ,�/ �`�'�
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Address
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City
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State
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Zip
/ 'F) a-YF/
Business Phone
( )
Contractor /Agent
C
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
Zip
Phone
(
Describe Work �
,51-L E. (.. -c"a k) E l r 1 L/P
Res. //
Comrn.
Subdivision /Plat Name /Short Plat Number
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
f'tt�is..? /
Comp. Plan
Census Tract
Number of Dwelling Units
i
Number of Buildings
l
Lot Size (Sq. Ft. /Acre)
Depth
/ 50
Frontage
/C)
Front Setback
8S.
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
LBUILDING INFORMATION
Square Footage
Number of Bedrooms
2-
Grouup
Type
♦
Building
��°Technician
Date
Is
es
- Sitire
Legal Description
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1
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Scale:
Date:
Revisions: Attachments:
Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
a
Legal Description
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1
•
0
Scale:
Date:
Revisions: Attachments:
DEPARTMENTAL REVIEW
I certify that I 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.
Signature
Approved
Cond.
Approval
Hold
75--- -
Environmental Health Application # Z1 6rfi
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W. 1101 College
Room 200 7 l
4!!l /�1d '�f�.- ,/ Cam—, �� / ' O s�
Planning /Zoning
N. 721 Jefferson
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/Engineers ,y✓ �, cC
N. 811 Jefferson i ,1/4''.3 Svc
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Utilities
N. 811 Jefferson
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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 to compile said application is true and correct.
Signature