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1985, 08-01 Permit App: 00006908 Carport (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) SHADED AREAS ARE FOR DEPARTMENTAL USE I Project Number C!P`{ Owner's Name LAST FIRST MI fJQ/ /hti//f rl, Hi S Project Address(Street Name&Number) Zip /`ici r. f /C,/i w 9 % Applicant Address City State Zip Phone 67z/� ��'1) r��_ acs"y Business Phone ( 2c.'Q:) '7 G ctS-7 Contractor/Agent Address CS/1/31/;:- City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State I Zip Phone ( ) Describe CAPPOP r /2Y 240 SubdivisionIPtait Name/Stmt f t Nu �y •/r� /� /��+ 4 7771f ir)O-P: r. I Lot Assesa4r P''ar'osi N,urttbar :;" Bloctc'. ,; plat"Ntttttb 025$ 2 = Zit)7 1 Pertinent Fite Numbers' zoneCom.Pta, Census Tract tdumberof Dwelling Units Number of Buildi ags Lot size(Sq.'Ft./Acre}' Depftt Fres Front Left Setback RI' tback tsar Sete Footage iY d C) Buttding Technictatt. t fe- • j " —,-75-5 DEPARTMENTAL REVIEW Cond. Approved Approval Hold Environmental Health Permit Number _i*J CO (0.5— • — a El W. 1101 College Room 200 ( , • Planning/Zoning 'ti Cl N.721 Jefferson I :., : -di //t //:_� • iL, / .- Air , de Engineers Permit Number ❑ 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 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 Date .. / / / it&- 1 - 1 ii 9/8 t Q. 1 . 1 1 1 04.1.A0 .__-, . it . 4 / . .,.•_....... i . 0.._ , . ,......c,.„ i f / r -,43 2