1986, 11-21 Permit App: 00014308 Garage(THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE !N INK
(Please return this original and your building plans to the Department of Building and Safety)
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Prolect Number ` �'fO
Owner's Name LAST FIRST MI
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Project Address (Street Name & Number) Zip
E 11`720 44Xcu t_ - Ave 1261b
Applicant
Address
City
State
Zip
Phone
Business Pho
Contractor/AgentAddress
L MCC&<<_
C'7. 37 %l
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Add ess
City
State
Zip
Phone
( )
Osgcrlbe Work . - .. .
I& rr ,4 -1) CyARAE ADD
Res,
Comm.
$ubdivislonlPlat Name!Short Plat N mberr�� _n GLt1 bio1."!
utaessor Parcel Number
Lot
Block
Plat Number
anent Fie Numbers .
ZoneComp.
Awa
Plan
Census Tract
Ae. Unita. ;,:
+ie,
Number of Buildings
1
Lot Size (Sq.
q. Ft./Acre)
i L C,C.V
Depth
Frontage
Left Setback, "
Right Setback
Rear Setback
R/ W Width
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Square Footage -
-1-, - 0' / T/ -5 c a
P
cc
O
2
2
Q
a • M
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Number of Bedrooms
- i :<- .
Date
Group
Type
. 04
6E
EE
9E
SE
4E
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6Z
8Z
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9Z
SZ
4Z
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iJ Environmental Health
�/ W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application II
Approved
Cond.
Approval
H,pld
Planning/Zoning
O N. 721 Jefferson
Engineers
0 N. 811 Jefferson
Utilities
O N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
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 t and correct.
Signature
Date