1985, 09-10 Permit App: 00007395 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)
Or-IPA/CU MnCMJ MnC run UCrMrt I IVICph I ML UJC
Project Number 7595
Owner's Name LAST FIRST MI
re, 2/ hn,./t— -
Project Address (Street Name & Number) . Ztp •
S 770 9' J>2F%, /ice o%x(071.. f/0 . Q-9 20 6
Applicant
;-7/4 i L 3n, //
Address .
City
SP•
State
w73r
Zip
??- 2-e96
Phone
( ) 9-2m- 2,7
Business Phone
( t
Contractor l Agent
Address
City
State
Zio
Phone -
(
Contact
License Number (Required)
Business Phone
( )
Architect /Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
I )
Lender
Address
City
State
I Zip
Phone
1 1
Describe Work _ -
rPu:r+� 6 A --&E (20)136/)
Res
Comm. ..
Subdivision/Ptat,Namel Short Plat Number'
rt
-Assessor Parcel Number
Lot,- - -
Black
Plat Number .
Pertinent Fila Numbers .r. .. .: ;-':.-. -
Zone -".,+...: .,
:Combo. Plant - -
Census Tract; -t.r',.:.'
Number of Dwelling Units- - •
- Number of Buildings •
Int Size (Sq:Ft./Acre) ,g''. ^'•-
r=
Depth r. --,-} ,'
Frontage:'. --c'-"-',
Front Setback • - -
Left Setback- .
Right Setback "..
Rear Setback -
-
Additional Information.. 1M _
DEPARTMENT USE
Square Footagej.
V /BO •
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Building Technician
In 1111 _
DateGroup
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Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number
•
Approved
lI � 1���
f �t
Cond
Approval
Hold
Planning/Zoning
N 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
ittties
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 _
4
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too
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