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1986, 06-05 Permit App: 00011408 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) n- - wnrnc n ren -rnn nrr.er OFIMLJCV MfICMo Anc- r -Un ULFr An I IVICIV I ML VJC J #-Ojeet N.mber . , U s lame AST FIRST Ml Project Address Street Name & Nu er) ,42-11 1vro4 Htadoul Ip 'AZO r, App icant Address city State Zip Phone t ) Business Phone Cori pactor/Agent t 6�ix c+ 0,4 Addresp Ci � � Stat I Z p„L Phone Conta LicenseLZ per iReGuired)Business L Phone Architect /Engine(* Address City State Zip Phone Contact Business Phone I ) Lender Address City State Zip J Phone l ) Describe Work 777= es. Comm. ,' Subd talon/Piatlarp Pber, te-IW, WS Assessor Parcel Number - Lot Block Plat Number ^- Pertinent Fite Numbers gone Comp. Plan Census Tract Number of Dwelling Units Number of Buildings i Lot Size (Sq. Ft.i Acre) Depth Frontage FrontSetback r � - Left Setback Right Setback Rear Setback RIWWidth Additional Information Square Footage ©2 � oc( Z 0 . ``Znn V Z •.<<:4m �i DM Ntmbergfoln 'Y'a•.tx + b 2 ++.. k 4'.N." .'R`.�,s`�hY »A faa , x.x:�rtq` +,'. � ..� Type DBteroUp ■7 u N 0 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 Date Approved Cond. Approval Hold Environmental Health Application # W. 1101 College Room 200 Sfil� V Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson 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 to compile said application is true and correct. Signature Date Show on Site Plan: Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street al Descri Additional Information: Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark Scale: Date: Revisions: Attachments: 1P , y i r , c • r