1986, 10-27 Permit App: 00013852 Reside(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)
Jr 1 F1 V C V /1 n CH J /'111 C FLin LiCr/1 fl I IV C IN I t L Li JC
Project Number / f152
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Owner 'sNarti; /��!//'' %� LAST �r S`� FIRST �%% MI
JJL ' ` �!/L/Y G si
Project • .r s (Street Name & Number) Zip
`-17 . 5 y/ F fitz,/ /2--teid,
Applicant .
- 4-- r
Address
W ..3f/'2 i.14_1_.a.e,,(
City
State
Zip
Phone _
9.
Business Phone
( )
Contractor /Agent
Alit ("7&C &ICZ—Z-i2-.4_
Address
j•
,..gi.6 2,--x______)
City
C/76
t
State
« '
Zip
9'f_cm /
Phone
(9, - 6e'G,
Cont
t.
]
License Number (Required)
Business Phone
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
(
Describe WDD Work. jJrI
Res.
Comm.
Subdivision/Plat Na /Sh t Number
/, d ^
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Sizeiz(Sq. Ft./Acre)
/CCO
Depth
Frontage
Front Setback rift Setback
Right Setback
Rear Setback
R/W Width
Additional Information
i>(..- tA-2,-z -L t)L, e)�
BUILDING INFORMATION
Square Footage
Idd d9
Number of Bedrooms
Building Technician
Date
Group
I Type
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
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Speclal 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