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1985, 10-15 Permit App: 00008090 Garagea' (THIS IS NOT A 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) ........moi. nrii—,. inn= r..r,..r..r, I wi G1'I I n u aroo iProject Number t5CDCr Owner's Name ick LAST FIRST I l La- WA-Prt�% A Protect Address (Street Name & Number)k Zip i57 /8g/V M-R/&'TrA Avg Cei02--7 Applicant Address l City State Zip Phone ( ) ' Business Phone ( I Contractor/Agent/A %C feJ.i4rd 5 . mi. /Iee Add ess /1-.).3902c, , S 3OL..r14 Cit PoKt4rJc State w Fq- Zip 99.=.o7 Phone ( ) 47,93 0-)y70 Contact License Number (Required) Business Phone Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone Lender Address City State Zip Phone ( ) Describe WorkRes. Der -4e thED gi4RAne (z1 X2& Comm. Subdivision / Plat Name/Short Plat Number JSAc nr; ('oro Mo6,L& //0M6,5 t s r' Assessor Parcel Number 6e552-0502 Lot 2- Block.Plat Number Pertinent File Numbers Zone_ l fl Comp. Plan Census Tract Number of Dwelling Units t Number of Buildings 2- Lot Size (Sq. Ft./Acre) Depth /17 Frontage 76 Front Setback Left Setback Right jetback % Rear Seise t R/W Width Additional Information ' BUILDING INFORMATION Square Footage Number of Bedrooms Building Technician Date iO—iS—g Group H-1 Type A/N 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 Date / U •- /S — Approved Cond. Approval Hold / Environmental Health Application -10 /O /S ^I r� W. 1101 College Room es rk\ is„ .10 p0 a/! /. it d Ji' ��NrP 7rd/ 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 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 Date / U •- /S — /h{k R►E7T{} I Show on Site Plan: Additional I ( I LotExisting Dimensions Planormation: ' -r--t t Str Proposed Improvements Lrndsaapige Hydrants —1— j i I I I (°J --_w_ Structure Setbacks Topography I 1 + I I ( 1 ( ry "— -_ ~'{--- t Easements Septic System (s) Lighting Signage -r4-� -r 1 1-1 — i__- --- - 1 1 I - I Water Lines Sewer Lines Shorelines— Highwater Mark — i I — �— I 1 Fences, Wells ( I I }— I •T----- T 1 — , Driveway(s) Right Way Width(s) _ _ ' 1 1 j 1 1 1 of Names • T ,• 1 ' i -1 j -1- L Front ng Street Flanking f t 1 ( 1 H a— I — i I, — — ( L j —I —f— - I I- r I — �-- 1 Street t I 1' {-, -t _4___L. I• i ! 1' Legal Description ( F 1 F t I — — — + I � rt !P/ I I— —4 — r l l 1 i l i II - i-- } �� i i• -41 { _i L1 -1 - 4 -1 1 I i 1 - f t- 4 1 1 i rt t 1 l_ j, '1�1 i L--- . 1 - .� 1 + 1 1 �� T T i �+T�- Ii I 1 T 1 T r r �� I + i rt � 7 -1--t-r�--L. t t 1 1- -._', - . -- _ -- _ , F -rt 1-- I } —7 1 ,- -4 (-I -j € - - 1 1 Fes- 1, -1--} -+ -I--il --- I H 1--- I i i \I r J • i —j-- } Scale. I I 1 1 -i -t Date: 7- I I_ + 1 -I- I I j 1 Revisions' Attachments: ,-f- ---f H -- f! h -r-Ti T i t L 1— t T-1 1 1�� ,� /h{k R►E7T{}