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)
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Project Number / ./
Owner's Name LAST FIRST MI
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Project Address (Street Name & Number) Zip
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Applicant
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Address �7
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City
Gtr, t._
State
(A)- V}-
Zip
9 4 20 c
Phone
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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
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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
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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:
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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
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