1986, 05-12 Permit App: 00010999 Attached Garage (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET 1? 50
•
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1i4
31
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE 1ProJect Number l Oq
Owner's Name LAST FIRST Al
Project Address(Street Name 8 Number) Zip
1 d ' l i) 1 97k4' &),9 99 2//
Applicant l Address
City State Zip Phone
Business Phone
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Contractor/Agent Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
Architect l Engineer Address
City State Zip Phone
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Contact Business Phone
( )
Lender
_ Address
City State Zip Phone
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As9asaFarcel Number Lot Block Piat Number
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Pero ifNumbers Zone Comp.Plan Census Tract
Dwelling Units Number of Buildings Lot Size(Sq.Ft.lAcre) Depth Frontage
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DEPARTMENTAL REVIEW
Approved Cond./
11.
Hold
�7 Environmental Health Application# _ • Approval
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W.1101 College
Room 200
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/Special Inspection Information
Project Representative Phone
Address
1 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