1986, 07-01 Permit App: 00011923 Garage(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)
SHADED A
Owner's Name LAST FIRST MI
/9/U.S6N ba)/q /s/() Z ;--( M 4 r 14
Project Address (Street Name & Number) Zip
cS - 3 4/ Z 2Ucc) c//5/ A 9.2,0&
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Add ess
City
State
Zip
Phone
(
Describe Work l
P`- tArC Ek -F_-0 6 frO 24t)/ 262 t
Res.
Comm.
Subdivision/ plat Name/Short Plat Number
M I P I (,° - 1401-110 r�
Assessor Parcel Number
335(-
020
Lot
"I
Biotic
7—
Plat Number
Pertinent File Numbers
Zone
5 FI2--
Comp. Pian
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth t
174
Frontage
dt
Front Setback,
II f/ _?
l
Left Setback
1
'G(�+ ^ v G
Right
9 7 c
Rear Setback
R! W Width
Additional Information
:ORMATION 1
Square Footage
Z
0
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5
a)
Number of Bedrooms
Building Technician
J 0 r.
Date
7- I- 8 1,
Group
' �Jjt
M-
�l Type '
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DEPARTMENTAL REVIEW
Approve •
►
Cond.
• pproval
Hold
.
Environmental Health Application /i
W. 1101 College J1
Room 200 F i
el
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
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 Date
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