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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, p 41 ... Applicant U I Address City IState Zip Phone ( ) Business Phone ContractorlAgent, r �—_ _dt____ Address City State Zip Phone p )7210/ -- Z/}A ___i qT --/ ?- ( -o6SS Contact License Number(Required)(26_6Business Phone i S SPe:DiGek. S 1•,6 ce ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( 1 Lender Address City State I Zip Phone ( Res. Comm. - ISt .Plat Number, r Parcel Number= - Lot Block —1 Plat Number , . 5 ` 25 .6 2 21�tnNumbers Zone Q Comp.Plan Census Tract .c ;. u 6 ling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage L tSetbadc Right Setback Rear Setback R/W Width Square Footage s e .:a;` z �- O 0 i U. �'"" Z aZ r 0 k` m Number of Bedrooms ext Group Type I. Mohr ' I I I j O KI p Crajk _7 • POKANE clacrS A.14d;-bo,, L5 a Z -4- -! 1`RU TUBE } ; . R (O-C.%e.14� i j lik .. _ I N . , I d i Exi_ ®1 I 3 r 1 i 3 11 ' 1 } T . . j '0.14."- I" c4a♦ate, f 0UE 6 T;o.^e. d 161hj \ �� d :-,r : ( ; 1 '�. \ , - -Pr��ed. Gar IT 31 t t i• • 1 I 1 1 t �p � 1 1 i 3 y-. . -. I;i 406 R iGUE, #fir. PQKq,NE, - A 99212 • (�09j 9a7—o 55 + I ' 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 ��