1986, 05-27 Permit App: 00011254 Garage •
(THIS IS NOT A 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 pro
lett
Nnmber.
Owner's Name LAST FIRST NI,
Project Address(St t Name&Number) Zia
(o 3 ZZ Sp r I e.�d - S�Q �A-�. 4010,
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Applicant U I Address
City IState Zip Phone
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Business Phone
ContractorlAgent, r
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Address
City State Zip Phone
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Contact License Number(Required)(26_6Business Phone
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Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
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Lender Address
City State I Zip Phone
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Res. Comm.
- ISt .Plat Number,
r Parcel Number= - Lot Block —1 Plat Number
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21�tnNumbers Zone Q Comp.Plan Census Tract
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ling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
L tSetbadc Right Setback Rear Setback R/W Width
Square Footage
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DEPARTMENTAL REVIEW
Cond.
Approved Hold
Approval
Environmental Health Application# / 4,
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.)
❑ 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.
As_ 2_7 -
Signature ' Date ��