The URL can be used to link to this page

1986, 05-15 Permit App: 00011105 MH(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) 011MV1.-lJ hf1LF1J ',ill- I vrl IJLr hfl I MLIN 1 /1L. VJL Project Number Owner's Name LAST FIRST ( FFIIRSST��' f MI wa v - 6 4e1 e e -I Project Address (Street Name & Number) Zip N 4i0* MkY14-5w R -D. Appi'cant 0 Wowe-1.11.. Address 43 707• �...it /�.�....A City State Lk)so% Zip ct9A, G Phone 009•( ) ?a 41-9Rgs Business Phone ( ) Contractor/Agent Add ess 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 ( • Workw` HOMO— Res. Comm. i 8 onlPlatrPe/$ho,� A umber 0 0~ Y� Parcel Number Lots l2 ...4 Block Plat Number Inert eNOrbers Zone Comp. Plan Census Tract ling Units Number of Buildings Lot Size (Sq. Ft. /Acre) Depth 140 Frontage ,S Left Setback'. = Right Setback ( Rear Setback R/W Width BUILDING INFORMATION Square Footage x r. C Number of Bedrooms _ ' Tem Date S I get Group h — 3 Type YN DEPARTMENTAL REVIEW 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 true and correct. Signature/P-464 DatS—/C—?‘ Approved Cond. Approval Hold Environmental Health Application W. 1101 College Room # 86 ""©Sb7 /glanning/Zoning N. 721 Jefferson ov �G % -GYL /yam • 0. £ . ? 5sy t Engineers N. 811 Jefferson O. , i / r/ 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 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 true and correct. Signature/P-464 DatS—/C—?‘ -1 -1- ) .1.5rigi 2Z 4-1 Shaw on Site Plan:. Additional Information: Descri Scale: Date: Revisions: Attachments: Lot Dimensions Landscaping Existing Structures DrainagePtan Proposed Improvements Hydrants Structure Setbacks Topography Easements Lighting Septic System (s) Signage Water Lines Shorelines Sewer Lines Highwater Mark Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Descri Scale: Date: Revisions: Attachments: