1986, 09-09 Permit App: 00013011 Garage ? 4 cl
(THIS IS NOTA PERMIT)
BUILD NG 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
trroject Number
Owner's Name 9kST FIRST MI
Project Address(Street Name&Number) Zip
741i1.3UL�vL � l�aiv�
Applicant Address
T's 2 r2 M C Qa,1 R L 1�;ES' !��w1 Ai)„Jt
City State Zip Phone
c K•
C 8 ) �-5o9 .
Business Phone
( )
Contractor/Agent Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender
Address
City State Zip Phone
Describe Work �' �'
.., . • Res. Comm.
Subdivision/Plat Name/Short Plat Number
7
Assessor Parcel Number- Lot Block Plat Number
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
9
ICI
Front Setback Left Setback
Right Setback Rear Setback R/W Widtt
h
Additional Information _ Square Footage
Z
O
F-
Q
2
cc
O
u. _
Z_
O
2
0
CO Number of Bedrooms
Building Technician Date Group Type
•
DEPARTMENTAL REVIEW
Approved
Approval Hold
Environmental Health Application# v 1:
❑
W.1101 College 10 ;4
Room 200 i
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.
Signature Date
I
Show on Site Plan: Additional Information: j I I I I I 1 T i 1
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Lot Dimensions Landscaping I I - ( ( f __ --
IIi 'l
Existing Structures Drainage Plan } j I ' - 1
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' -- (_ 111
Proposed improvements Hydrants f I I I i I �r �Ui � _I �- _ �ICv-{ - - '-
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Structure Setbacks Topography } ' I ( I I I + f ` 1 r .
: 1 1 1 1 1
Easements Lighting
- - + _
9 9 I I t _
Septic System(a) Signage - + ( 1 1 I I I I i - 1 T
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Water Unes Shorelines 1 -' — } -- - -5 C—.1� — fi _._- �__� t—
Sewer Unes Highwater Mark - , ( ' _--- , � -+ -
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Fences,Wella ! w I ( I ( i I I '_ I I I- 3 I
Driveway(s) 7 I
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Right of Way Width(s) - I ? +- - �_ I _ t I
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Names of — I __ ___..1—_--4 I_ __I .-_ f ..
Fronting Street -t r + _ } -— I I - __� r + — 1 — — _ - - - - -r f
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Flanking Street -- --- - �_.__- - t----i---7----
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