1985, 04-19 Permit App: 00005025 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)
Project #
Owner's Name LAST FIRST MI
,TEVL,N SILL. I'
Project Address (Street Name & Number) Zip
,�, //i 8 'ii tYE 9 ',20'
Gty��D��N�
State�� �
Subd�Isi�nlPlat Name
I'll Ril hec u l vc Ade/
Assessor Parcel No.
e5_1/ / - 11 / 2
I Lot /�
�L/
Block
/ I
Plat # /
'�Cn C
Zone Act. M
Zone 8
ti
kl- SO
I Census
Tract
Dwelling #
/
No. of Buildings
/
Lot Size (Sq. Ft. /Acre)
Depth/yj
/W
Frontage -6
Front Setback
Left
ti
Right//
_ \// ST/ /k%fy
Rear
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
Contractor
S,V2
Address
City
State
Zip
Phone
5 Cmc — a7/a
Ozntact
License No. (Required)
Business Phone
( )
Architect / Engineer
Address
City
I State
I Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
(
Describe Work
A-tmc hecl ac.rK Cie, Y72C ,
Comm.
Additional Information
1 DEPARTMENT USE
Square Footage
Building Technician p
041-1(.4)
Group
H l
Type
VA
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.
Signature Date
Ap.roved
CpApproval
Hold
/Environmental Health
W. 1101 College/
Room 200
Application # 6 b
O r
, (°�
/ / r
vile
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
Protect 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
1_
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7 /
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