1986, 06-20 Permit App: 00011706 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's Name AST FIRST MI
/ 1111 L
Project Address (Street Name & Number) Zip
L 7/ a 540.. f (P 7Y -2 Z-
ApplicantI
aa
Address
City State Zip
t i
Phone
(509) qz&- 4r8(0
Business Phone
( )
Contractor/Agent
Address
City
State
I Zip
Phone
( i
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
( State I Zip
I
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State I Zip
IL
Phone
Describe Work
(c.3/ rc-c - k' _.d esz_-_-e_ 400 1 TIov..)
Res.
Comm.
Subdivision/ Plat Name/Short Plat Number
N P Si -lo PS A 00
Assessor Parcel Number
/ z ik — 2(002
Lot
3, 4,5
Block
e
Plat Number
Pertinent Fife Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
i
Number of Buildings
!
Lot Size (Sq. Ft./Acre)
"(037.5
Depth
1Z
Frontage y�
&55 J
Front Setback
Left Setback
Right Setback
Rear Setback
R/ W Width
Additional Information
BUILDING INFORMATION
Square Footage
/6,66 9
Number of Bedrooms
Building Technician
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Date //
f -20-FICA
Group
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Type
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i Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application #
Cond.
Approved Approval
tf‘I
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
❑
Other(SEPA/CrltIcai 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
c� efre,
Date
1 01........_ 0:a_ n1___
iut u1111uns1ons
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark