1985, 07-17 Permit App: 00006571 Residence(THIS IS NOTA PERMIT) '
BUILDING PERMIT APPLICATION WORKSHEET
276
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)
Onqucu MnCMO Hnc run ucrnn 1 IVI CIV 1 ML. I.JO
Project Number`r ( 7)
Owner s Name LAST FIRST
I - • SC.444.9i-21 Z 1,..:
MI
Pro/ect Address (Street Name & Number) Zip
R 1.320 C, 1 -os s tr
Applicant
-Thk7 IJ 0.1 t S C L A -9-k. t
Address
K1 1 3 st) . RAGA )
City
MCA --C\
State
W IA-
Zip
9 902-(
Phone Q
( 1 I-/66 - L/6 a )
Business Phone
Contractor/Agent
1.4N.S eL+S-ekIL
Address
N l 3.sbs" aLa.sS,c y
City
Ma0
State
1(-) Ar
Zip
910'a i
Phone
1 1 X146,-y62I
Contact
License Number (Required)
T it.1 LCC. a 13 a r,
Business Phone
yvogrv"( ) 40.11 i-4 V
Architect/Engineer
-g-P1.179-14.-767 ,. De -s I4W -
Address (\
NI 1j4O� O \VI S;v....l
City
SPol._•a,.,c
Staid
(,o e}-
99Zo&
Phone
( ) 4S'3 r71. Oa
Contact
TE--FFr SPe.,-6,
Business Phone
i )
Lender
Address
City
PO Kovc
State I
W 4-
Zip
Phone
I )
Describe Work
Ctsci oCt CE Cif /GARAC&
Res, /
Comm.
Subdiviys ;/ Plat Name/Short Plat Number
LJrPo 2 ILMJI l Y l 'X'ArF_ ono Aoo
Assessor Parcel Number
. 2754.1 - 943i
Lot
1
Block
Plat Number _ 1
Pertinent File Numbers
Zone S I Y✓
Comp. Plan
Census Tract
Number of Dwelling Units
/
Number of Buildings
I
Lot Size (Sq. Ft./Acre)
Depth
136
Frontage
go
Front Setback
Left Setback
Right Setback
Rear Setback
Additional Information
I DEPARTMENT USE 1
Square Footage
x(0282 ,ter
SQ6 zF
/CiS = lie
562 = GAR .
03 -mock'
Building Technician
tellat i
Date •
-7 — 1'7 --SS
Group
e 3
Type
Vail
DEPARTMENTAL REVIEW
_
Approved
Cond. Approval
Hold
i Environmental Health Permit Number
W. 1101 College,,,
Room 200
C5 {f
/5%+J
//i
�iC��
Planning/Zoning
N. 721 Jefferson
Permit Number
%W14
ijJt/
'7-. 7-
/Engineers
N. 811 Jefferson
Utilities
N.811 Jefferson
S
Plan Review/Fire Prevention
N. 811 Jefferson
�0
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection information
Project Representative '
Phone
Address
I certify that I have mined this application and state that the information contained in it and submitted
by me or my agents true, correct, legal, bipding. �
Owner's Signature
•
Date
Afe-111LkNl4P
106 TITLE
OWNER/CONTRACTOR
DATE
JOB LOCATION
CONTACT
ADDRESS
PHONE
•
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