1986, 11-06 Permit App: 00014025 Garage(THIS IS NOT AFERN=!T)
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
Project Number I -)t61745
Owner's Name LAST
FIRST M I
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Project Address (Street Name & Number)
Zip
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Applicant
Address
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City
State
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Zip
Phone
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Business Phone
Contractor/Agent
Address
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City
State 1
Zip
Phone
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Contact
License Number (Required)
Business Phone
Architect I Engineer
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
Res
Comm.
Lot
Blockry
umber
N
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70
Comp. Pian
Census Tract
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Number of Buildings`
Lot Size (Sq.Ft. /Acre)Depth
Frontage
Q
All
16ft back e
Right Setback
Re2l Setpadc
RI W Width
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Square Footage
in-
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Number of Bedrooms
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Group
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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 a t c ile said application Is true and correct.
Signature Date
�1����
Approve
Cond.
Approval
Hold
Environmental Health Application ff
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson L I
Plan Review/ Fire Prevention
N. 811 Jefferson CJi�IItT�♦�T� FtI.�FF�L)
6r- PLASiS
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 a t c ile said application Is true and correct.
Signature Date
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Show on Site Plan:
Lot Dimensions "
Additional h nation:
Landscaping
Existing Structures ✓
Drainage Plan
Proposed Improvements
Hydrants
Structure Setbacks ,
Topography
Easements ✓
Lighting
Septic System (s) ✓
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells i
Driveway(s) ✓
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
s