1986, 02-12 Permit App: 00009684 Garage _ (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 (. cr
I Owner's Name LAST FIRST MI
Project Address(Street Name&Number) Zip
3a {)nrLh L )1 ey 1Q1 �9,Qi.
Applicant Address
Lt ry Z ra V\c - c,t2 _
City State Zip Phone
( )
Business Phone
( )
Co
Iryclot/Agent Address
c/1(?_ � �s JO A)Lee
City State Zip Phone
i (509) 53V-41Lity-
Co ct License Number(Required) Business Phone
e 4 OZ i e PARI F4‘,751_0 ,L Z ( I 634/ '4,3 '
A hitect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
i
Describe Work Res. Comm.
C1 ONf2 A Cy C ( t--1, `)/ c1. ,.
Subdivision/Plat Name/Short Plat Number
-Pp ir"4 C. ll 0,—c> a r^�;'a ,'-c-tic-P rte,
Assessor Parcel Number Lot Block Plat Number
IS 2_-- 2.-0
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front Setbackl ( Left Setback Right Setback i Rear Setback R/W Width
Additional Information Square Footage
‘ OC . S° z
0
P
Icc0
u.
z
o
z
0
J_
5
m Number of Bedrooms
I�'Iding T nician Date ! Group Type
/i.z f�-A 'Inv
DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Application#
W. 1101 College
Room 200 2—`2_ /�
25-e^ .% i ��-7. •
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention I I
❑ 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