1986, 07-07 Permit App: 00011619 Garage, Addition(THIS IS NOT A PERMIT)
BUILDING PERMITAPPLICATION 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)
SHADED AR
'
pPro(ect Number
Owner's Name . LAST (/�' FIRST
AZ.TMA/A7? e (/'T ��(7 `
oRy �" id
"�
Project Address (Street Name & Number) ( /
Zip
/=2sO 2/c e $/'a/ lvc lel, �.0/4 99Ze.a�
APGliran,E//So3
t
ress
City
55oge,0.G'
State
WAS/'I
Zip
79z0 6
Phone
(sv9) 9z 6 -41e90
Business Phone -
($0t) 9z7.6gat
Contractor/Agent
SA4erFz .4s A So sv,
Address
City
State
Zip
Phone
(
Contact
License Number (Required)
Business Phone
Architect/Engineer/ /�
SA,Ure A5 Aeorug
Address
City
State
Zip
Phone
( )
Contact
Business Phone
Lender
WA5aivlydd, X107V46--
Address
.
City
State
I Zip
Phone
.Describe Works::., , i. ,,,
tri�
xr :E.•,. a i
,,,E -,, ti . .
c, cD' �j We1DENcE"kormok\
Res.
Comm,
Subdivision/Plat
Name/,Shoit
Plat Number
- - - -
AssessdyParoel
.y',' \�•4' ((/!�
Numbjei
{� 1(
Lot
2
Block'
Plat Number
Pertinent Elle Numbers'; f:,.._ ��.
Zokn -liis
Comp. Plan
Census Tract
Number of Dwelling Units°i, -- - - -,
Number of Buildings
Lot Size (Sq. Ft./Acre) .
Depth
t
Frontage
-
Front setback`�`;'��; ;��:: `-
'Additional
Left Setback
Riht Setback'
9 t
Rear Setback',%.
RIW Width
Information;' ,._
'S:- _ �• ; .r� .: F.r ._
:�,� :"BUILDING INFORMATION rs al
Square Footage
6412-:-/““ =554 4
4;*,.A,fit.:.«.,,:,..,4',:`.fr=,:1'ra.:�:c .-. ..
'
._
Number of Bedrooms
- _
-ou
BUltding T. '_ ',
"
er
Date .
per
r
Grobp
Type
0
0
(
DEPARTMENTAL REVIEW
1 certify that 1 have examined this application and state that the information contained in it and submitted
My me or my ag t to compile said application is true and correct.
Date
Approved
Cond. Approval
Hold
5
Environmental Health Application / i ‘,,53/a,
9-1,
!/
�j
W. 1101 College
Room 200
�(//� f� ,/"/,,, % 1/',y�� %,�)
4.0 — 1 t/CY a-�i/ss le IYIII & ‘..741,749.XJG/AHr* Gf
'
t . - - 7�/..YiL1
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
`�
SIVS4
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
Phone'
Address
1 certify that 1 have examined this application and state that the information contained in it and submitted
My me or my ag t to compile said application is true and correct.
Date
ut d J wt 1
�. l I SO3 A.LW-A c
,14
0
i
N®iJ.ma O,5-OcJO2II
ul
0
4!t
,o, az
pp �riijY'r!yi�i