1986, 06-11 Permit App:0001515 Lean-To Addition(THIS IS . 0T., 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 1 , S 1
Project Number
Own me LAST FIRST MI
lect Address (Str Name & NAKer) Zip
Dp-
Applicant Address _
13 @ 9 S
City State Zip Phone
912,Business Phone ) 41 �
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Contractor /Agent Address
City State Zip Phone
( 1
Contact License Number (Required) Business Phone
I )
Architect/ Engineer Address
City State Zip Phone
Contact Business Phone
Lender Address
City State Zip Phone
<: Res. Comm.
6 �AF->tJ l-6AAJ- m r2 x
Plat Number
AC RAO
'00 Lot Block Plat Number
dM
10 M
Zone Comp. Plan Census Tract
Aasa
ifs Number of Buildings Lot Size (Sq. FtJAcre) Depth Frontage
Right Setback Rear Setback,_ .. R/ W Width
Squsfe<Footage _
Z 1
O
Z5 H
T
cr
LL
Z xNumber
m Of BedfOOR18
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Group ..,� TYPe
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01
701
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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
AI
- Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
i1
Planning/Zoning
N. 721 Jefferson
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 to compile said application is true and correct.
Signature
Date
Snow on Site Plan:
I IWFUOVu In1E71UVU111C11us
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
I Description
Scale:
Date:
Revisions: Attachments: