1986, 03-20 Permit App: 00010131 Garage(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)
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project Number
Owner' Name
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LAST FIRST MI
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Project Address (Street Name & Number)
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d Zip
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Applicant
Address
City
State
Zip
Phone
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Business Phone %
Contractor/Agent
Add
ess
/ 2
City f
State
►t4tL) +347
Zip
DC(
Phone
( )
Contact
--
License Number (Required)f
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Business Phone
( ) 92.6 -- 3.
Architect/Engineer
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Address
City
State
Zip
Phone
( )
Contact
Business Phone
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Lender
Address
City
Stale
I Zip
Il
Phone
I
Describe Work 1R
(LAPP' Ga (1-,) 24 zGt
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Comm.
Subdivision/Plat Name/Short Plat tNNumber �l �¢ � � j
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Assessor Parcel Number
'''. I 1W 2-c(05
Lot
Block
Plat Number
Pertinent File Numbers
Zon•
Comp. Plan
Census Tract
Number of Dwelling Units
1
Number of Buildings
2-
Lot Size (Sq. Ft./Acre)
Depth )
rfCO.ZS
Frontage
20,-9'
Front Setback.` /
t_ .- `" ('L.. ,!',1l,
Left Setback I
r^D —
Right Setback
—
Rear Setback .
R/W Width
Additional Information
I BUILDING INFORMATION
Square Footage
Number of Bedrooms
Buliding Technician
1r '-
Date
3 a70 -4ZS(F,
Group�/
y
Type
�1N
DEPARTMENTAL REVIEW
Environmental Health
W. 1101 College
Room 200.
Application p
Approve
i
/4
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
O N. 811 Jefferson
Utilities
O N. 811 Jefferson
Plan Review/Fire Prevention
0 N. 811 Jefferson
Other (SEPA/Crltleal Material/etc.)
Feet 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 Date
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