1985, 08-05 Permit App: 00006691 Carport(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)
an/11./cu Hftma Anc run utrMn I IVICIN I HL UOM
Project Number
Owner's Name��((�� L�AA�ST FIRST MI
06G12St ULa vi n-e_� "1 ..
Project Address (Street Name & Number) /' - Zip
ea 1I�13 Fredertc/< 3 L,k4"-e_ q4do(,,
/�� /'� I,,' L
A II\caanto 01.
l 1CI. ll IA-Q.J rr.a VJQ1—S-a
Adddrrrest
�` __/
5w i1 Y(U ir-stem(./(
City
s(2.lLaw�
State
lv%�}
Zip
q�fao(p
Phone
so9) qL o33/
11
Business Phone
(So9) 53 a - 4,372-
ContractorlAgent
Address
. _
City
State.-
406k.
Zip
Phone
( 1
Contact
License Number (Required)
Business Phone
( I
Architect/Engineer
Address
City
State
Zip
Phone
( )
contact
Business Phone -
I - )
Lender
Address
City
State
I Zip
Phone
1 )
Describe Work •1
6A P -9011A- C 9 `( 7.0 )
Res.
Comm. .
Subdivision/Plat Name/Short Plat Number -
M (IZA13)Fnv /14JC 4
Assessor Parcel Number
09 41-0343
Lot
7
Block
3.
Plat Number
Pertinent File Numbers
Zone1��
�5L
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontag I
Front ackIr
Left Setback
Right Setback )
Rear Setback
Additional Information
I • DEPARTM ENT US E
Square Footage,_
Building Technician
.JO -
N m
Date
s/s%9s'M-
Group
I
Ty pe..
U�
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
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
A 657o 7
- 5
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
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 is true, correct, legal, and binding.
Owner's Signature Date
1
-1
4
r
-j
ft1 r
{
I- 4 r .
Cig
ryrr
L
I I I 41 rr I •
ACJ I
r 1-i
�i � ! I
I - 1
4
- -r
•
-r
1
J I 1 1
-1-
r–
k-1
1-
i r F
4-
Vj i 1 I I j
II r -f
I
1
I
iL
1
LJ J
_f rt
-r-
I' 4h r
1
I I rt it
I !
Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Widths)
Names of
Fronting Street
Flanking Street
Landscaping
Drainage Pian
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
1
-1
4
r
-j
ft1 r
{
I- 4 r .
Cig
ryrr
L
I I I 41 rr I •
ACJ I
r 1-i
�i � ! I
I - 1
4
- -r
•
-r
1
J I 1 1
-1-
r–
k-1
1-
i r F
4-
Vj i 1 I I j
II r -f
I
1
I
iL
1
LJ J
_f rt
-r-
I' 4h r
1
I I rt it
I !