1985, 10-15 Permit App: 00008050 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)
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Project Number
LAST FIRST
Owner /ems - .
Project ddress (Street Name & Number)
S • �f319 M A I A) ,4t)C
Zip
.5"-er, (c . 9 et 2-o 6
Applicant
Address
City
State
Zip
Phone
( ) 925,- 67 2 71_
Business Phone ' /-j
Contractor/Agent
Address
City
State
Zip
Phone
( 1
Contact
License Number (Required)
Business Phone
Architect/Engineer -
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
( )
Describe Work �y
kipPTIA&E 24 Y 2-4
Res
Comm.
Subdivision/ Plat Name/Short Plat Number
4 Sd6Piul9(otJ
Assessor Parcel Number
II. zz513 - I.2ZG
Lot
(2-
Block
'2—
Plat Number
Pertinent
Pertinent File Numbers
Zone
Comp. Plana
Census Tract
Number of Dwelling Units
Number of Buildings
2-
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Fron�tbac� A 1
9 T11`+
Left Setback
Right Setback
Rear Setback
R/ W Width
Additional Information
IBUILDING INFORMATION
Square Footage
Number of Bedrooms •
Building Technician
400 ill ,
DateGrouP
o -rS-Sr
M—r
Type
VJ %
DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or r gent to compile said application is true and correct.
Signa
%
Date / U —
Approved
Cond.
Approval
Hold
Environmental Health Application
W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
L
J
N. 811 Jefferson
N.811
L
i Pian Review/Fire Prevention
N.811 Jefferson
Dem
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 r gent to compile said application is true and correct.
Signa
%
Date / U —
Legal Description
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howon Site Plan:
Additional Information:
Lot Dimensions
-..00811441-Stiiiiitiire8-:.'f
Proposed Improvements
Landscaping ,
Drainage-Phii
Hydrants
Structure Setbacks
Topography
Easements
Septic System (s)
Lighting
Signage
Water Lines
Sewer Lines
Fences, Wells
Shorelines
Highwater Mark
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
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Scale:
Date:
Revisions'
Attachments:
•
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