1986, 10-08 Permit App: 00013527 Carport(THIS IS NOT A 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)
VI IPI LJ L.v P111LPfJ r111L. I 'JI1 LJLF P111 I IVI LIV 11*L VJL
Project Number /352_7
Owner's Name LAST FIRST MI
G, t'-! /7-,J4i74 P rl Lph
Project Address (Street Name & Number) Zip
'qy8 01-'vA- V Q e /7 t),Q2 X 792.96
Applicant
-,1‹,/7/1./ g , C/z L
Address
City
3 pok'.61 •7C
State
L4 )/
Zip
972,-
Phone
I )
Business Phone
( )
Contractor/Agent
)6 170) ,Qick9 y 6c,v (va,77R# 07.' 2
Address
r) <7 6k /3S.�—
City /
State
Zip
Phone
Contact
License Number (Required)
doh /21 R0xa3a D 2,
Business Phone
(S<) ) s 3 Y-6 Ci c47
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
( )
Describe Work
4-rr-A(1E-ID eAk►p--o r.T( ii )(DI)
Res. '
Comm.
Subdivision/Plat Name/Short lat Number
\f ;. 'A oAr•Lam- Ile IG 4-7-5 (/ tEI
Assessor Parcel Number +�
/L/51ILJ SS
Lot
/
Block
Plat Number
Pertinent File Numbers
Zone AS
�
Comp. Plan
Census Tract
Number of Dwelling Units
t
Number of Buildings
I
Lot Size (Sq. Ft./Acre)
X13 i til-
Depth
Frontage
Front Setback ts
t�fa_.,�/4a..
Left Setback
Right Setback
Rear Setback
of /5T/fir...
R/W Width
Additional Information
1 BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
(
Date
its --8-56
Group
kJ_ ,
Type
vt
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
❑ W. 1101 College
Room 200
Application #
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Utilities
❑ N. 811 Jefferson
Pian 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 Date
T '
s ! t
I -:-J
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