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HomeMy WebLinkAbout1986, 06-11 Permit App: 00011504 Addition (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 ( 7 Project Number Owner's Name LAST FIRST M I 616 5 5a iri Project Address(Street Name 8,Number) — Zip 1 r_; /4' . / iii`571 sL C 17d 4v'7t ' 7,91-12-- Applicant Address 1 Zi City State /) _- Zip Phone ( ) 9 Z6 -Z 1 Business Phone 1 �� ( 1 Contractor/Agent Address -- `"" City State Zip pha.;$ t _ CnR1551 --- License roumner teeputr©d) ©csiaas_Pks,nw -_- - -- t ) ,2antiiiii7gneineer —— s38itrena ..Y 3£916 - lir - - - nano 1 I ti ni�1 , riusina;23 Ptlnne — i F®nnec Agsinn I i nhY $iQ£9 igiR Frionat t ) rD J7_ {(\ .y,., Rel;: 6e5arlbe Yllorh " f 1 f ( Ce Y \------ {r'4mm; i�, - � i s k.,;,..13 CF —�--... — Sidktdirisien!Plat NarnelShort met Number y-o Assessor Farce!Number Lot Blnek Plat Number • Pertinent File Numbers Zone Comp.Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size(Sq,Ft./Acre) Depth Frontage Frt nt tbiiGlt i1 Left Setback L - q Right,etback Rear Setback R!W Width Additional information `` •Square Footage z O r--- I I 2 cc 0 Z. 0 z 0 5 m Number of Bedrooms Building Technician Date Group Type DEPARTMENTAL REVIEW Cond. Approved Approval Hold Environmental Health Application I / c W. 1101 College ; Room 200 /leaf Q yen„," Planning/Zoning ❑ N.721 Jefferson i4nggFB ❑ M 477 jail-arson UHIUI2! ❑ RI.all itattlfF59R Plitt R�'rleirlFi�©Pi-erention ❑ N,1311 Jefferson �- Pr, r .. Other(SEPA/Critical Material/etc.) 111 El Fast Track/Special Inspection Information Project Representative Phone ACdrela I certify that I have examined this appiicatipn and state that the information contained in it and submitted by me or my agent to compile said application I3 true and correct. _ ( ( Signature ��-�-� h .-�r�1/fG Date °����� ~��= _ _ __- _ _ _- ~ . ^ ~ - -- ' Show onSite Plan: Additional Information: Lot Dimensions Landscaping } Existing Structures Drainage Plan --- Proposed Improvements Hydrants • 8bu:lumSetbacks Topography Easements Lighting Septic System(o) Signage Water Lines Shorelines Sewer Lines MighwmberK8urk Fences,Wells | Driveway(s) Right of WayVWdth(s) + -t Homes of Fronting Stree . Flanking Street • . Logo Description , � , , , , • A ill : ___,„._ *,. :: __ I :I,' ; : III - j• I I I , , . ...i .t.. ,, _ .. I: . 1.1:_. ';'.1.--- -.-,- .tl_---sii ii i • ------ ---- __;_____;__._ J_ ___ .f._ — ___ _f____ 1___ I t_H.-IIC;X:ITIL__J' .11--rIII '''' ----I4--- t -t t t-- E • -.E1: -- 4- -- 4-1i --1---: _-/--1; 11 --mm"~ | Scale: li 11 | | | | , Date: 7 --' - �Revisions: Attachments: -_ _ / � 1'_i�_� 1 i � � -� — |«" | ' I— i i ~ —�— ^ I. • ~ . i,: �