1986, 11-21 Permit App: 00014315 Storage Bldg 1
(THIS IS NOTA 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
P{oJeCt,Numt ///5
Owner's Name LAST FIRST MI
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Project Address(Street Name&Number) Zip 6, 3 3 G/,,.12 6-/ / / A e_,-7-
ApplicantAddress
Cit State
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Business Phone
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Contractor/Agent Address
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City State Zip Phone
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Contact License Number(Required) Business Phone
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Architect/Engineer ,,//,� ,(� /_/� Address /
4.44147-- co ,
City State Zip Phone 744,)////-- 9-s-'
('47.2 0 ic.6 4/e,.:7€ ,?/-Clot_ i e ( )
Contact Business Phone
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Lender —'Address
Address
City State I Zip Phone
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`'�` _ -4' Comm.
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Subdivision/Plat Name/Short Plat Number
Assessor Parcel Numberd Lot Block Plat Number
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'ditilo'(.1711
Pertinent File Numbers Zone Comp.Plan Census Tract
5 ries.
umbeOf Dwelling Units . Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
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t ,-,.,. � t ar 1. ; ; Right Setback Rear Setback, . . R/W Width
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Additional Information
Square Footage
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DEPARTMENTAL REVIEW
Cond.
Approved Hold
Approval
Environmental Health Application# �9�`� ��
84 '
W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
I 1/7)/ir
Plan Review/Fire Prevention
❑ N.811 Jefferson az
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Other(SEPA/Critical Material/etc.)
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❑ 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
,. Show on Site Plan: s Additional Information:
Lot Dimensions Landscaping
Existing Structures Drainage Plan
Proposed Improvements -yang
Structure Setbacks Topography
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Septic-System-41 3i - •
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Sewer Lines 14+g#wva2er-Mark—
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