1986, 07-03 Permit App: 00011952 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)
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Owner's Name LAST F T MI
Z!�7012 / iei
Project Address (Street Name & Number) ,, Zip
/./07107.5 1 4e0,4fi 67Do�Qr2Ja Q4206
Applicant
/42/45 r-c/le!
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i2 „356-6 /22a e,er/
City
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State �/"_,
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Zip
''9Po7
Phone
( )
Business Phone
mop) "7/84aooa2
Contractor/ff gent��`/ _�
Add
ess
�e.7
74/4 c:h
,ePs
/2
��5� 7 / .•el
City
(S 2 r e
State
Zip
gfao 7
Phone
( )
Contac .
Lice se Number (Required)
Business Phone
/�/ ,Qs n�
� B�
(09) z
1, 1-7:
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
Describe Work
6,e C 0 E )
G �
Res.
�--'
Comm.
Subdivision/Plat Name/Short Plat ��J Numbern
O I'^ . .11- Pp
Assessor Parcel Number
125.3 f - 5-70 I
Lot
Block
Plat Number
Pertinent Fite Numbers
Zone
Comp. plan
Census Tract
Number of Dwelling Units
1
Number of Buildings
2.
Lot Size (Sq. Ft./Acre)
Depth
l 8 ''
Frontage
(. 3
FrontackX I
Left Setback t
Right Setback
i
-4 i
Rear Setback
RI W Width
Additional Information
Square Footage
z
O
F
4
2
x
O
I
2
O
_2
G
_J
3
m
Number of Bedrooms
Building Technician
Q I t�/� ri
J`/
D�a/te
[ 3 6
Group
-1 ..\
0
DEPARTMENTAL REVIEW
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.
Sign
Date 7/3/8
Approved CpApproval
Hold
Environmental Health Application #
§i'pk_..
W. 1101 College
Room 200
v
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.
Sign
Date 7/3/8
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