1986, 08-20 Permit App: 00012781 Garage(THI IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
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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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Project Number / ,/ 7ei
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^Owner's Name LAST FIRST MI
Prc ect Address (Street Name & Number) Zip
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Applicant (
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Address
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City
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Phone ( y) 9...8---242 7 7
Business Phone
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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
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Approved
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Cond.
Approval
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Hold
Environmental Health Application #
W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
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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
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Legal Description
Scale:
Date:
Revisions: Attachments:
■
T-
41
4�-.