1986, 09-25 Permit App: 00013383 Garage(THIS IS NOT APETWIT)
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 Number _.ge....
Owner's Name LASTFIRSSTMI
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Project Address (Street Name & Number) Zip
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Applicant,[/�/J] �+ s ,,s
Address .`G, /]/ei
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City
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StateZip
.99c:707
Phone
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Business Phone
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Contractor lAgeyn� / //
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Addres
5355 /71aei/e/Si
City
40A�e
State
Zip
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Phone
Conta
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License Number (Required)
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Business Phone
•(-61)6 T C32QQp.G/
Architect/ ngineer
Address
City
State [Zip
Phone
Contact
Business Phone
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Lender
Address
City
State
Zip
Phone
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Describe Work
Hes.
Gomm.
Subdivision/Plat Name/Short Plat Number
.: -ssor Parcel Number
Lot
Block
Plat Number
a Inent File Numbers ... - -
Zone , :.
Comp, Plan .,
Census Tract
berof Dwelling Units
Number of Buildings
Lot Size (Sq. Ft'/Acre) ..
Depth - - : Frontage
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t Setback
Lett Setback .
Right Setback
Pour Setback •
itional Information
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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
Ap•roved
Cond.
Approval
Hold
Environmental Health Permit Number
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PAL
W. 1101 College
Room 200
Planning/Zoning. 4
N. 721 Jefferson !
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Permit Number
Engineers -
N. 811 Jefferson
Utilities
N. 811 Jefferson
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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
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