HomeMy WebLinkAbout1986, 11-12 Permit App: 00014100 Garage(THIS IS NOTA PERMIT)
BUILDING PERMIT APF LICATION 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)
•-a. irs vLv r-11 11-•11.! /11 11..- 1 VI1 ✓Lf /1111 IVI LI♦ 111L IJ%J G
oject` tVumb r���
41
Owner's Name LAST FIRST MI
67- J re/ 4; e-- ' G6/, ,L/ :,q, r
Project Address (Street Name & Number) • Zip
4 // 30 C. -6.:/ "/7e4— .S4 `y 4/ ,57 �.f.--z. 0 6
Applicant,
/ a j c r --v 4---/L-',0"
Address
4 // O G 4..i,i C
z.)..70State
.4..f. 6
Zip
rt -e o
Phone
L57 y (5,2i) 4,5 -oz y
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
i
(
i Lender ,
Address
City
State
Zip .
Phone
( )
® i- ".Worka F
r `£
k` a x„ ( _ isY
Z..c�'v' •;/� tr�,x"� cwfa''re.`H.�'
Resr
Comm
re .1 ("Y
f$utidtfiii(ottt ate `m S ". titiNumber 4 :
t.��yxr a,, ,r
Assesso,' Perice( urn
3- F } =
st
Lot .•
At
y,Piat Number
sr-
(nenj FIie':NumberS
�a t "�...� � -
'Zone ',
m Plana � � "
p
Census Tract
wit ber`Of Dwettin oits N
4..-,, . ,,3-�„*
Number of Buildings
,s y. > -.:
Lot Size (Sq.Ft:/Acre) 3
., "" su
Depth"`
v'j•
Frontage
two
�Leff Setbacks
Right tback f
'r4't 'a.
k Bear setback
s q,
R/WWidth 4
i +Kh y-
tbai tnformatl r
'� 3 �
r
_�'+9^aa >, � �'� fp �.+✓}R'&�� 3 r *� 4 � $ d � �'Y S" �Y` "`. Z
IATION '1,,
Square Footage<
xg
'ai 5,�4"µ'� {R 5' ✓+E i., ^ '* 3 -s E{ $ ¢`tXR w '=
F`^ � a�..�w'w.
.... .b' R�45"2 �ME«ai px4% `�,''+�*w..N^„Ns' ., < .�'3 wb'.�i ',``-:n' aa•R.,:,STRv 'r
�5:�"
N:
.: t � ..,._ . .
f,3-^..tgy s .... ,„ _.. .,> .,• �'v �.`>`�ti s .,
2-::
O
£
'*"u j ✓ i; ...
� yr
Y� wksx m&� •qr �� f. 5;�+�5"���� n � ..�4a w,'3.. � � {-
1 t ' BUILDINOANI
N _ _ �nSk
}' '
_ a: ""�' ,P�,, }>S` # ? `^ t rr fit'. "�# �•i Kai j`
.gymw
Numberol Bedrooms
a° -A 'x
)BuHdin•giedtn�
jD�ate% v
Group`
-Ty
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,i�Ai'f
Date 1/` 42—
�fj
X
Approved
Cond.
Approval
Hold
Environmental Health Application #
lj�
t
''
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
'Engineers
N. 811 Jefferson
I
Utilities
N. 811 Jefferson
Plan Review/fire Prevention .
N. 811 Jefferson -
1�
Other (SEPA/Critical Material/etc.)
t
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,i�Ai'f
Date 1/` 42—
�fj
0
Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)Signage
Water Lines . a
Sewer Lines ' '
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Shorelines
Highwater Mark
Legal Description
7
,
! I
•!
' !1 I 1
;
; I
•
tf-
•
, 1
• I I ,
1- '•
i • .
i r -
. •
1
• . • •
- • -t: -f
• -1
I•
r
t L 1- • •
; 1.: •
: 1
T,
1,•
I 1
T
. -1 .• •
i .
.• !
! !I
!