1986, 06-23 Permit App: 00011752 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)
0r1MUCIJ Mr1CMD MFC rk.in LJCrerl i lvlr et I ML UDC
Project Number
a-752..
Owner's Name LAST FIRST MI
/5e A •
Project Address (Street Name & Number) Zip
/ ; /— E. 7t1'/1/ Greeye�cas , (�4t. ,?did
Applicant
Address
City /(
State / r Zip /r
1
Phone
Sod (sy) acf7�
h
Business Phone
( )
Contractor/ Agent
Address
City
State
I Zip
Phone
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
i Zip
I
Phone
i 1
Contact
Business Phone
( )
Lender
%
Address
City
State
I Zip
Phone
(
to A T`r-AC 1-16 0 GA RACE (Zn X 26)
Res.
Comm.
i ortlPlatNamelS rt Flat Nu
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,s>r,Parcel Number
/7553- %27
Lot
2_-7
Block
Plat Number
Pertinent File Numbers ,
Zone
Comp. Plan
Census Tract
Iumb4 Dwelling #!nits
Nu r of Buildings
Lot Size (Sq. Ft. /Acre)
Depth
Frontage
Left Setback
Right Setback
Rear Setback
R/W Width
Information
I BUILDING INFORMATION
Square Footage
7__E P
}
F,.
Number of Bedrooms
xn " " Date
� . `� &
Group l
— i
Type
V NI
DEPARTMENTAL REVIEW
I certify that 1 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
Ci Date 6 - a 3 r`?
Approved
Cond.
Approval416.
Hold
/ Environmental Health
W. 1101 College
Room 200
Application #
08000
Si
Q%
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities %
N. 811 Jefferson
I
Plan Review/Fire Prevention
N.811 Jefferson
�B'b
0&/—
&LOther
Other(SEPA/Critical Material/etc.)
Fast Track/Special Inspection information
Project Representative
Phone
Address
I certify that 1 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
Ci Date 6 - a 3 r`?