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1986, 08-20 Permit App: 00012781 Garage(THI IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET e2 6° 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) J ri,1 LJC LJ P1n CP1J P1nC r Lin LJCr P1n I IVILIY I P11- LJJI- Project Number / ,/ 7ei I ^Owner's Name LAST FIRST MI Prc ect Address (Street Name & Number) Zip /// / ' ,vim )671/5s5/0/2/ ?y C Applicant ( 5/41-/4' 45 aee✓,vel2_ Address 4-Y� t-,74-iii,- City City cc f j State C I C c��k,Qrt� j Gc,�� , i Phone ( y) 9...8---242 7 7 Business Phone i/ Contractor/Agent Address City State Zip Phone ( ) Contact License Number (Required) Business Phone ( ) Architect/Engineer / Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone ( ) Describe Work Res. Comm. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number I f Lot Block —r Plat Number Pertinent File N_lmbers Zone Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./Acre) r! fern Depth Frontage Front Setback Left Setback Right Setbai S Rear Setback R/W Width Additional Information BUILDING INFORMATION Square Footage 6,72- l Number of Bedrooms Building Technician • r 1 M Date Y. - Group Type 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 �j % /� K! `;$W9 Approved 6Z(' -gr `�� /� Cond. Approval e/ Hold Environmental Health Application # W. 1101 College Room 200 ►-, 7-( /$// -. g !,/ /',' '' /;L l i / /11 / Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson I 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 Legal Description Scale: Date: Revisions: Attachments: ■ T- 41 4�-. Show on Site Plan: Additional Information: Landscaping Lot Dimensions Existing Structures Drainage Plan 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 i �j Legal Description Scale: Date: Revisions: Attachments: ■ T- 41 4�-.