1986, 09-09 Permit App: 00013082 Garage(THIS IS Nr T. 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)
JrlHL/CU rAncr‘a r+nrun v�rrAn I rviCry I HL VJC 1Project Number /3 OF 2_
Owner's Name LAST FIRST MI
erapiMgiER" 4, Do 0
Projecjec Ad ress Name &Number) /Zi
3ZRe A� TARW Pb ��o elm ('2 t• 7" 1 S
A scantAddress
K's IkIc.
/yam � N. 5770 k'b.
$'csr?AU$
State
No
Zip
3A /
Phone
/ (Jot X73-.247;3
Business Phone
( )
Contractor /Agent
o. k'$. 7".11
Address
a 4 „A .-•
City
sr 7,14-ts
State
Fite.
Zip
t3Seri
Phone
/ (.sop h?s-.757.3
ntact
License Number (Required)
ON Kt& C'UUKSZ/SO
aF
Business Phone
( )
Architect/Engineer
d S/eWe7
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
L Zip
Phone
( 1
Describe W
' e'TTA°+t..g4 6r4 Rayls (eatii.�)
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
0fla«1 P►tb A VC.
Assessor Parcel Number
040 64:mS. 44-4
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of BuildingsLot
-Z
Size (Sq. Ft./Acre)
Depth
141
Frontage
85.
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
BUILDING INFORMATION 1
Square Footage
Number of Bedrooms
Building Technician
Date
Group
Type
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application #
Approv
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
❑ Fast Track/Speclal .nspectlon 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
</r
Dater 9-77
I
1
92f
do,
Front of� Builling F�cing
NOTE: {The lOaxitim height of a
t-4
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