1986, 09-17 Permit App: 00013174 Shed (THIS IS NOTA PERMIT)
BUILDING PERAPPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original
SHADED and yourAREAS building
AREFOR plans toDEPARTMENthe DepartmentTALUSE of Building and Safety)
P►oJectNumbat
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Project Address(Street Name&Number) _ Zip
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Applicant 7)- Address
City /� State / Zip Phone
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Business Phone
Address
Contractor/Agent
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City State Zip I Phone
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Contact
Address
License Number(Required) Business Phone
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Architect/Engineer
City State Zip Phone
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Contact Business Phone
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Lender Address
City State I Zip Phone
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Describe Work ,- a
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Subdivision/Plat Name/Short Plat Nuumtbeer fx
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Assessor Parcel Number Lot.F �,; Block Plat Number
Pertinent File Numbers Zone `Comp,Plan Census Tract`
Number of Dwelling Units Number, of Buildings Lat$ize{Sq Ft./Acre) Depth ` Frontage t
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Front Setback Lett Setback _,RightSetback t, , FfearSetback R/W Width
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Additional Information Square Footage
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Type
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Building Technician Date
DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Application#
2 1101 College
Room
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
f 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
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Show on Site Plan: Additional Information: ,
Lot Dimensions Landscaping t - 1 +____-� i..._fi __ _ _.4__._
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Existing Structures Drainage Plan '
Proposed Improvements Hydrants 1 -_`
Structure Setbacks Topography t I }! _ _ ___ _
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Septic System(s) Signage - -
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Water Lines Shorelines
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Sewer Lines Highwater Mark - . -+ _ -_ _ I i _ -_ .
Fences Wells
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