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1985, 07-30 Permit App: 00006606 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) SHADED AREAS ARE FOR DEPARTMENTAL USE p� Project Number Owner's Name LAST FIRST MI Project Address (Street Name & Number) (2-O7 jjF1zD Applicant City State Zip go2j2-. Zip Address Phone I ! khL,2) Business Phone ( ) Contractor/Agent Address City STC KPt- N State Zip 2(9 /L-' 3 5' —2 Phone g ‘7b Contact License Number (Required) Business Phone _ Th I- y- L - L.8 • tt T& ( I I) Architect/Engineer Address City State Zip Phone Contact Business Phone Lender Address City State Zip Phone ( 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 pp Apprrovov al Hold / Environmental Health Permit Number /(9©3 1-4(45—.(\, W. 1101 College 200 0 Planning/Zoning N. 721 Jefferson Permit Number Engineers N. 811 Jefferson Utilities N. 811 Jefferson I 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 Show on Site Pian: Additional information: Lot Dimensions Landscaping Existing Structures Drainage Pian Proposed Improvements Hydrants Structure Setbacks Topography Easements Lighting Septic System (s) Signage Water lines Shorelines Sewer Lines Highwater Mark Fences, Wells Driveway(s) Right of Way Width(s) Flames of Fronting Street Flanking Street Legal Description :tea Scale: Date: Revisions: Attachments: f 4 d , z , t ,