1986, 04-14 Permit App: 00010469 Detached Garage •
(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
Owner's Name LAST FIRST MI
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Project Address(Street Name&Num( �(
Number) Zip
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Applicant Address
City State Zip Phone
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Business Phone
( )
Contracto /Agen Address
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City State Zip Phone
pc9 ,C)- (...P , ' 1 c (,. ) k-J-05 //,
Contact License Number(Required) Business Phone
1,01— MS(3 ( S1 Pi ( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
Describe Work Res. Comm.
D i 4CJ E0 c;A-RA(30 vie
Subdivision/Plat Name/Short Plat Number
Lor 5T FA-RA.45 -LE RR
Assessor Parcel Number Lot Block Plat Number
Pertinent File Numbers ZoneComp.Plan Census Tract
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Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
2-
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
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P
Q
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CO Number of Bedrooms
Building Technician Date Group Type
I NIG) 4-4-86 M- 1
DEPARTMENTAL REVIEW
Cond.
Approved Hold
] Approval
Environmental Health Application# i S ~ U/(i9 ii- / '
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.)
CI
❑ 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 to compile said application is true and correct.
Signature Date ___
% Show on Site
ne Dimensions
ns
ilnit StE f -__urns
Additional Inlerrnati
Landscaping
Drainage pian
Hydrants
Topography
Lighting
Sloane
Shorelines
Highwatef Mark
Flanking Street
Attachments: