Loading...
1985, 11-06 Permit App: 00008541 Garage Addition(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) v• •• •v=v rte• • /9v r`11•- 1 VII 1./1-I /11111111-11 1 /1L VJG I Protect Number�5 Owner's Name LAST % FIRST MI "��lt!i //11� Project Address (Street Name & Number) Zip CX26' 0/1 gG " 21.x._2 S. -e-, 79‘).3 7 Applicant 1JR4-I O e-i..e4Y C] Address ��,/ /�'2 el- e e .�- cee 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 Address City State Zip Phone �( •r ,�q yy�r F�Ik.= �„r�• CiCgitm. Su1J41/Yision! last Name/Butt TMH Assessor Parcel Number 2555t/ - 0503 101 Biotic Plat Number Pertinent File Numbers Zone Comp. plan Cana Tract Number of Dwelling Unita o tot Size We. FL /Acre) Depth Frontage Front Setback Let n o Night8etbaok Rees R/W Width Additional Information , z Square Footage 0 t 2 z Ili. z 0 z W.. CCI Number of. Bedrooms Building Tec niclan t/ -r/ Group Type vN 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 G� Date /1/6 Approved CpApproval Hold Environmental Health Application # �/� W. 1101 College C,�` - ,E7 Room 200 �J Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson �t;� 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 G� Date /1/6 v-...�.-q.� _ _