1986, 07-22 Permit App: 00012223 Pool(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLic.:;ATION WOkKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF HE FORM YOU UNDERSTAND
COMPLETE I l4 INK
(P(ease return this original and your building olailS to the Department ot Building 31-1c1 Safoty)
btlAtitli AHLAS Arlt. 1-U1-1 Ln -_-_,-N i f1.1 t- N I /10_ t_r Z) t.:
Project Number Z ....
Owner's Name [AST NA,
ect Address (Street Name & Number) 2tn
5'97
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City
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Phono
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City tate
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Phone
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Contact
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LICerVit.- Number (Itequi,ed)
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Architect/Engineer
Acilress
City
State
Zip
Prone
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Contact
Business Phone 1
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Lender
Address
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State
Zip
Phone
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4e3orPceI Number
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Lot
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Ptat Number
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Comp. Plan
Census Tract
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Number of Buildings
Lot Size (Sq. Ft./Acre)
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Depth
Frontage
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Left Set
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Right Setback
Rear tback
R/W Width
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SqU&O Footage
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Number of Bedrooms
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Date ,.
Group
Type
DEPARTMENTAL REVIEW
1 certify that I ha
by me or my a
ttocompi
Signature
ned this application and state that the information contained in it and submitted
said ap •iaid Ion is true and correct.
IOW
Date
Approved
Cond.
Approval
Hold
Environmental Health Application # l9,Z
1
W. 1101 College
Room 200
i
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I. 4
Planning/Zoning
N. 721 Jefferson ..
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 -
1 certify that I ha
by me or my a
ttocompi
Signature
ned this application and state that the information contained in it and submitted
said ap •iaid Ion is true and correct.
IOW
Date
J;:unt Or,,:, : r.a<<:
Aoaitioual 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
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Legal Description
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