1986, 09-23 Permit App: 00013264 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 AREAS ARE FOR DEPARTMENTAL USE
— ' Project Number
3.24
Y
Owner's Name LAST FIRST MI
° t.. '� / i/=') a // L 1 yd
Project Address (Street Name & Number) Zip
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lllL5
Appy ' / / l
Address `ci 4
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 k ,
A ---cc 4t.1.4 61:) Cid C24X2C.
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
NIA ptLrb flfte 400.
Assessor Parcel Number
3S4'\ -62.1t.` -t
Lot
'-.7
Block
'"'2._
Plat Number
Pertinent File Numbers
Zone
'dig 1g...
Comp. Plan
Census Tract
Number of Dwelling Units
1
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
c+�
Left Setback
Right Setpack
Rear Setback
Rt W Width
Additional information
BUILDING INFORMATION
Square Footage ..
&rib 45
4 ft,,..50
Number of Bedrooms
Building Technician
Date
Group7vtri
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
W. 1101 College
Room 200
Application #
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
g2i46
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
j