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
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Buttding Technictatt. t fe- •
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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
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