1986, 05-07 Permit App: 00010898 Deck (THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
6ffel (Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE 1ojNumber 16� }, Q
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Cwner'sNam LAST FIRST MI t j C/
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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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Contractor/Agent Address
City State Zip Phone
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Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City ( State Zip Phone
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Contact
Lender Business Phone
Address
City State Lip Phone
( )
DescFit Work - Res. o Comm.
p
w /Plat Name/Short Plat Number `
Assessor Parcet Number Lot Block Plat Number
Pertinent File NumbersZone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft /Acre) Depth Frontage
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Front$ett>ed4 � Left Setback Right Setback Rear Setback Rl W Widiti
Additional Information Square Footage
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DEPARTMENTAL REVIEW
Approved Cond. Hold
4...i 9SY ' Approval
Environmental Health Application# a
2 W.1101 College
-(.,m 200 t ' I 0 '
M 't--- Y-6 6616? -iocS-0S-'6,3e
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities I
❑ 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 J R 7...1.4