1985, 07-16 Permit App: 00006419 Storage Building 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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number
l
Owner's Name i LAST FIRST MI
M4 p,, v Act r^ r y
Project Address (Street Name & Number) Zip
.. 1301,A/ Gczli/S/.J S�a4.ai. e Zr2 /6
Applicant
gA,toter, h/.e.
Address
//MeC�ivi
reu/
City State
Se "47 •, e Cv.<F.
Zip
97-,..c is'
Phone
(ro%) 9-2..,x —2-:-7—t G
Business Phone - - -
Contractor/Agent
-ie. %, 4�fe l- tri SP "
Add ess
�, ////f ;i rvieid
City
vc-ie7,2 e
State
441
Zip
99, 0 6 .
Phone
(5 9) 9j... -2-7 .a_E
Contact
License Number (Required)
Business Phone
Architect/Engineer
Address
City
State
Zip
Phone
Contacts
Business Phone
( )
Lender
Address
City
State
Zip
Phone
Describe Work. ° - -
9 ADD oN -TO EY/s &ca. crteAGE-�2x e
i i ,s 'L
Res.
Comm.
Subdivision) Plat Name/Short Plat Number
'r.rY-1 gigs V4if,—yt Vie—Ch VTR
Assessor Parcel. Number
i5, II/ - 05o9
Lot
Block
Plat Number
Pertinent. File Numbers
Zone As
Comp. Plan
Census Tract
Number of Dwelling Onits
Number of Buildings
Lot Size (Sq. Ft./Acre)
x,2015
Depth.
Frontage - -
Front Setback,_,. -
Left Setback
Right Setback
1
Rear Setback
/5
--
Additional information -
DEPARTMENT USE
Square Footage
1 .F
Building Technician
41-ctt
Date -
7—i�-85
- .
Group,. . . m;=
Type'_. ...,,ro,N
M—if
Vhi
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 is true, correct, legal, and binding.
Owner's Signature
Date
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
(�
W. 1101 College
Room 200
i �•
!��
1—
0.nn�AA 1��1gg_ � `
Planning/Zoning•
N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson N
4
Utilities
N. 811 Jefferson
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
Date
Show on Site Plan: Additional Information:
Lot Dimensions Landscaping
Existing Structures Drainage Plan
Proposed Improvements Hydrants
Structure Setbacks Topography
Easements Lighting
Septic System (s) Signage
Water Lines Shorelines
Sewer Lines Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
►. 1
'
1
m
ccid
0
m
w
13"
0
0
a
Show on Site Plan: Additional Information:
Lot Dimensions Landscaping
Existing Structures Drainage Plan
Proposed Improvements Hydrants
Structure Setbacks Topography
Easements Lighting
Septic System (s) Signage
Water Lines Shorelines
Sewer Lines Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
►. 1