1985, 06-07 Permit App: 00005815 GarageBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name ( (last) (first) (m)
/� I C. h� �S 1 �! / Ci{Y\
Department Use Only
f13s. Comm
2 Project Address (not Mailing Address) a Road Name Space Zip
r_ 1 3/! 6 OO)1 _ , a-16
3 City/Community
,S p d 1c- 12_
State
C(..)
Subdivisil Plat Name
r Le Val/ey hew Q1---Iittefditir
lNo. I �'
4 Assessorii4Parcel l ... O
Lot/
/
4` /
Block
* * * DEPARTMENT USE ONLY
5 Sic
Zone Act. #
ne
/
Project No.
6 Dwell # i
No. of Buildings
2
Sq. Ft./Acre
Depth
1 9,5 1
Frontage y
150
7 Set Back -Front
. XI'2TtA
(L)S-1
.-
(R)S-2
,
Rear t
5a
Census Tract
_
Module No.
Initials
; JU, m
16 Architect Firm Name
Street Address
Zip
City
_
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City
I State
Phone
( )
Contact Person
License No.
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone5 O / /
/6
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ New
❑ Add/Alterd/
❑ Replace
❑ Move
❑ Other
/� �./❑gDemo
14 Describe Work 6A 0 v#'ce E — C..s, Ax L
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
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