1984, 07-05 Permit App: 00001038 Garage BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Department Use Only
i7 6 Q d_k- Q- F F" S . Res. Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
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3 City/Community State Subdivision/Plat Name c
Pa/L'�AlE u- A i tl u iew cs T-
4 Assessor Parcel3
No. Lot Block
"( 54 _ C>(_0 . 'Z Z * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.0 Zone Project No. 1/ V / e
6 Dwell 0 No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front I(L)S-1 (R)S-2 1 Rear +Census Tract Module No. Initials
1
* 16 Architect Firm NameStr et Address
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Zip Cite ClState Phone
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City [State Phone
( )
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than 01 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) I SEPA Exempt(Y/N) Date
15 Type Work X.Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo Add/Alter ❑ Move
14 Describe Work Ct0 u"'ett7 5 CP 2-4( T 14 0(141 J `ref //jJ Ef
10 Applicant Name Street Address
11 Zip City State Phone
( ) 92L - z1GSc
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information