1986, 10-06 Permit App: 00013486 Garage diumle
(THIS IS NOTA F'ERMIY) f3eo. 5
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 6436[Project Number
Owner's
[ProAST ST Mt
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Project Address(Street Name&Number) Zip
EAST j 4o 3 VALi-C---/wA," QQr214f,
Applicant Address
City State Zip Phone
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Business Phone
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Contractor/ t
rd, Address
717°6 E..
City State Zip Phone
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Contact ) License Number(Required) Business Phone
i�C/ Jpo ,4 �1
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Architect/Engineer Address
City ` State I Zip Phone
I ( 1
Contact Business Phone
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Lender Address
City State I Zip Phone
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Describe Work Res. 0 Comm.
O rA(it&.Zj 4R.AGE (36)-0 ./
Subdivision/Plat Name/Sho -tNumber
i'a.V.TZJA,.f
Assessor Parcel Number Lot Block Plat Number
/ "5- 413 / 72 z-23 !l 7
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
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Front Setback Left Setback Right Setback Rear Setback ✓ RI W Width
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Additional Information Square Footage
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Building Technician Date Group Type
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Show on Site Plan: Additional Information: ; i • - ' ' 1 1 •
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Proposed Improvements Hydrants ! , ' • —
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Septic System(s) Signage
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Application# -6
❑ W. 1101 College /1yl
Room 200
i2 Puw.va JC IrylArofr Lr-4rO,C
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