1986, 09-03 Permit App: 00013105 Duplex 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)
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Owner's Name
LAST
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Project Address (Street Name & Number)
Zip
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City
State
Zip
Phone (
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Business Phone
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Address
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City
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State
Zip
Phone
Contact
License Number (Required)
Business Phone
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Architect/Engineer
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Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
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Comm.
Lot
Block
Plat Number
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Zone
Comp. Plan
Census Tract
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Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
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Right SetbackRearSetback
R/ W Width
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Square Footage
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Number of Bedrooms
Techn
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Group Type
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Scale:
Date:
Revisions: -
Attachments:
Show an Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
Landscaping
Drainage Plan
Hydrants
Structure Setbacks
Topography
Easements
Lighting
Septic System (s)
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
- - - - - - -
Flanking Street
Scale:
Date:
Revisions: -
Attachments:
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DEPARTMENTAL REVIEW
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
Cond.
Approval
Hold
Environmental Health Application #W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson ►.�� /< �1_ f /�
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 to compile said application is true and correct.
Signature
Date