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1985, 08-20 Permit App: 00006999 Garage(THIS IS NOT A 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) VI •rrvt_v ni il_n., /1nL I San VLr/11-1 I MLI\ I /1L %JO I Project Number �' 5G Q ,p � r Owner's Name LAST FIRST MI Project Address (Street Name & Number) Zip 1 l k ,> E k— k---0 t:--- -Z.-% k > `5') 7c, Applicant t� n __...‘-k,-"" �/ Address 113 t to e , t---) -D V. -Ac 4tCity City o� AaNtr State kL., Zip 9`7)2.0 co .1e— Phone ( ) e32.2 c�`13 Business Phone ( ) —14`1 1 t4'FS Contractor/Agent Add ess City State Zip Phone ( I Contact License Number (Required) Business Phone ( 1 Architect/Engineer Address City State Zip Phone ( 1 Contact Business Phone ( 1 Lender Add ess City State Zip Phone 1 1 ribs Work Res. -ems Comm. Subdivision!Ptat Name/Short Plat Number Assessor Parcel Number Lot Block Plat Number Pertinent File Numbers Zone Comp. Plan Census Tract Number of Dwelling Units Number of Buildings u Lot Size (Sq. Ft./Acre) Depth , Frontage Front Setpack . .Left Setback . Right Setback Rear Setback Additional Information DEPARTMENT USE Square Footage 'Building Technician Date; N i',1i i 'r� Group Type 1 Environmental Health 0 W. 1101 College Room 200 DEPARTMENTAL REVIEW Permit Number Approved 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 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 a.:. t is true, correct, legal, and binding. Owner's Signature Date i >1 PRoPERTy PRcecDSED CgAR&eE tale)" 1__\t -AE Q 0 C 34-0 C`o E>:G• HouSE - n 'I N v Q \/ PLOT FLAN! t/16"=1Lo" Gx. en^y =Q ` pgoPosEb �n D1a..\V EwAy M ADD1TIbPU CUiB 1 1 3 1 . i`rz E Daft x CX., Av E. . ti S