1986, 03-05 Permit App: 00009893 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)
JnMUCU MftMO Ant run utrMn I MGIN IML lib=
Project Number
Owner's Name LAST FIRST MI
-PfLi/ Rtp.rz S. -
Project Address (Street NameT& Number)_ /�','',,_,,((''yynn %%//n 5190,4-a,,,-- / �,(� Zip
7 6c✓//l ,r !" - 9'9? -14
APPIIcant�S.22-3
Address
City
State
Zip
Phone (Sat ) F -2V - 7f a- ?
Business Phone
1 )
Contractor/Agent
Address
City
State
Zip
Phone
I )
Contact
License Number (Required)
Business Phone
Architect/Engineer
Address
City
State
Zip
Phone
1
Contact
Business Phone
( 1
Lender
Address .
City
State
Zip
Phone
Describe Work i
0424,0 air
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
RI I,Le r ke...4,2,64 244D ,
Assessor Parcel Number
21544 — 1 Dg
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
I
Number of Buildings
1
Lot Size (Sq, Ft /Acre)
Depth
f 24 I t
Frontage
75'
Front Setback
-NA
Left Setback 1
8
Right Setback
—
Rear Setback
—
R/W Width
Co l
Additional Information
IBUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
Jur Ini
Date
3 -5 -8G,
Group
M - I
Type
UNI
Environmental Health
1[] W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application #
(77 cG
Approved
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Utilities
O N. 811 Jefferson
Plan Review/Fire Prevention
O N. 811 Jefferson
0
0
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