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)
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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
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W. 1101 College
Room es
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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 —
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Show on Site Plan:
Additional
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LotExisting Dimensions
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Septic System (s)
Lighting
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Sewer Lines
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