HomeMy WebLinkAbout1985, 11-21 Permit App: 00008854 Residence(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
Project Number i)
Owner's Name
LAST
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Project Address (Street a &Number)
Zip
Applicant
Address
,Zip
City
State
Phone
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Business Phone
Contractor/ Agent
Address
City
State
Zip
Phone
Contact
Lice se Number (Required)
Business Phone
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Architect/En eer
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Address
City
State
Zip
Phone
Contact
Business Phone
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Lender
Address
City
State
I Zip
Phone
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Describe Work
Res.
Comm.
Subdivision/ Plat Name/ Short Plat Number
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Assessor Parcel Number
-2-7
Lot
Block
Plat Number
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Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
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Front Setback i
Left Setback
Right Setback
Rear Setback
R/ W Width s
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Additional Information
Square Footage
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Number of Bedrooms
Building Technician
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Group
Type
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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 to compile said application is true and correct.
Signature `�=-�� Date <�
Approved
Cprov
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers %q , ,7/
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 to compile said application is true and correct.
Signature `�=-�� Date <�