1985, 08-14 Permit App: 00006882 Carport(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)
SHAIJtL) AHtAS AHt I- UH UtVAH I NI LIN I AL Ubt
I Project Number <, Z/ l 52-
Owner's Name I l LAST FIRST MI
V illeevt T r�5Ah L,
Project Address (Street Name & Number) Zip
/320a7a/10i yO. nnO___ v(ifrL, 9y2/X
Applicant
Address
City
State
Zip
Phone ,
1 ).
Business Phone
1 )
Contractor/Agent
Address
City
State
Zip
Phone
1 )
Contact
License Number (Required)
Business Phone
1 )
Architect/ Engineer
Address
City
State
Zip
Phone
1 )
Contact
Business Phone
I I
Lender
Address
City
State
Zip
Phone
Describe Work
CARPoPr(2iX31)
Res. / v
%
Comm.
Subdivision/ Plat Name/ Short Plat Number
C-u7E}pra \!Wr f viEw VTN
Assessor Parcel Number
i 551/4 — 0623
Lot
A.
Block
2 -
Plat Number
Pertinent File Numbers
Zope
i/�Vi>B
Comp. Plan
Census Tract
Number of Dwelling Units
I
Number of Buildings
2
Lot Size (Sq. Ft./Acre)
Depth
/35
Frontage
90
Front Setback 3/
Left Setback
Right � �ck aRear
0Square
Setback
Additional Information
DEPARTMENT USE
Footage
Group
M— 1
Type
Building Technician .
/�,hr; te)
Date
0—i'i—S5
_
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number 9/13
Approved
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
.Engineers
❑ N. 811 Jefferson
Permit Number
Utilities,
❑ N.811 Jefferson
LTJ• 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 is true, correct, legal, and binding.
Owner's Signature 1 V4 t 7frVt. QP\ t/it / Date
8 -/ti --s
ADDRESS: /32/10 1 IHTT Loo
General -
ETCne'rship
O Applicant
O Contractor
O Architect
IUPA--d//d r e ss
IdLegal Description Planni
VD//arcei Number Unplatted Property?
Lot Depth: Width > 3:1?
(Less than 10 acres)
Lot Depth: Width > 4:1?
�� (10 acres plus)
Gelining Lot Size Less than Minimum?
Q4Cto Plan Segregation of Platted
Property?
J/❑ Plat Map Setbacks Less than Required?
t7 Permit Description Frontage less than Required?
CJS ans Not a Permitted Use in Zone?
❑ Completeness Rezone, Conditional Use,
Variance Involved or Required?
❑ Square Footage Commercial Use or Home
Occupation?
O Occupancy Group d Type More than One Residence?
0 Departmental Releases Adjacent to a Required
and Conditions - Shoreline?
En ineerin
New Access/Approach?
Private or Unmaintained
County -Road?
Sepa
Underground Tank Over
10,000 Gallons
PROJECT M:
Health
Increased Lot Coverage?
Addition Bedrooms/
Fixtures?
Change of Use?
New Septic?
Commercial Building Over
12,000 Square Feet?
Over 20 Dwelling Units?
Over 40 Parking Spaces?
Agricultural Building Over
20,000 Square Feet?
Landfill or Excavation Over
500 Cubic Yards?
Critical Material
Designated as a Critical
Use Activity?
REVIEWED BY:. (MadC-HT
Yes No N/A
I\ I`I`I\ I`
7
DATE: 08AIMS
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