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1985, 09-05 Permit App: 00007313 Garage(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) ofHUCu F1nCN0 NnC run uCrNn I IVICiv !PAL UDC - „/ o� Project Number / ./ Owner's Name LAST FIRST MI .14 -i -s c iti._c- i A (cr._4_, Project Address (Street Name & Number) Zip S0 7 S-11. FO' e --,,z..<_. g',,L f`'0 0..6 Applicant > GU'i •4-4- z -'t// -<!(i. �(! Address �7 !- "9 . ?_ C,T'L R z.._.. City Gtr, t._ State (A)- V}- Zip 9 4 20 c Phone (.5,)1 ) q z 6 - 84'1 b i Business Phone (.5-'7.75' l q08-Ogl0 Contractor/Agent Add ess City State Zip Phone ( ) Contact License Number (Required) Business Phone ( ) Architect/Engineer Address City State I Zip I Phone ( ) Contact Business Phone ( ) Lender Address City State I Zip Phone ( Describe Work ATI -Ac i o A(222'/) kit X) Res. Comm. Subdivision/Plat, Name ort Plat Number ) PPoe ru,vi -r / Assessor Parcel Number 25V2 — /Cr 2 -- Lot Block Plat Number Pertinent File Numbers Zone /4-0--SU'3 Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./Acre) 12W0 Depth *65 Frontage Front Setback Left Setback Right Setback Rear Setback Additional Information ENT USE I Square Footage _ I- tr a W Building Technician (jl/,) Date Q --5—e6 Group ' Type 14— 1 i X! lei ZEnvironmental Health W. 1101 College Room 200 DEPARTMENTAL REVIEW Permit Number Cond. proval Approve Hold Planning/Zoning ❑ N. 721 Jefferson Engineers ❑ N. 811 Jefferson Permit Number 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 I certify that I have examined this application and state that the information contained in it and submitted by me or my agent is true, correct, legal, and binding. Owner's Signature . e w • 'tet' `�"� Date., (S 116S Show on Site Plan: " tattinfeht1601,;::, • -=-= 00,100atfucAttraa !Pak IMPreiritrninia$krac1vra Setbacks' OktitS Watdelleas Sevierlines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Additional landecaphig, „ ,Drainage Plan 'Hydrants Topography Lightint, shohiliaei Highwater Mark Legal Description N Seri- OF S1/2_ (IF teP/-- or W'4 7 Ig‘TZ. • " - • r R T ,JE t✓ G ARACE fc i 3 Sol -e--r 1C ° C1C Low Ptvt °Np Sc ALE)