1986, 10-09 Permit App: 00013546 Garage (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
Project Number /3 5 LA!
/
Owner's Name LAST FIRST MI (O
ii- IT
Project Address(Street Name R Number) Pbnt � �� Zip
F" / (//i W a bashes - p Karg e_ QQ t 4
Applicant Address
(7Drni ait 5-J"rocli'cpri E 6/U "- Ltitor;ver Dry
Cit State Zip Phone3poKaa-,.e
1.314- 99, e)7 (,-57-)y)
Business Phone
t5Z:V 1459 s7/D
Contractor/Agent Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
/VC)ierylATC 4 c ipzi(1,D__ ( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender I Address
City State Zip Phone
( )
Describe Work Res. Comm.
ATt-AC I E C7 0-412.40-&(14 X j,L �-
Subdivision/Plat Name/Short Plat Number
t i)c-LLEsCe , Aloor 'iTJ/
Assessor Parcel Number Lot Block Plat Number
/3 _ 1 pig 8 2.-
Pertinent
Pertinent File Numbers Zonew r Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
;Front Setback . Left Setback Right Setback Rear Setback. RAN Width
Additional Information Square Footage
576 V
z
0
. I-:.
cc
z
• Z
• o
y <„ ;) m Number of Bedrooms
""�I�� �.' � �Date Group i Type
.
it-,41
4111111.01111.0111111.16o 4111111101.11111111111111
{
DEPARTMENTAL REVIEW
Cond.
_a 3ct
APProved APProvalHold
Environmental Health Application# 7� I
LrJ W. 1101 College
Room 200 494
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
0 N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
o 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 .' �� [!i'1d() 17.t rn Qit 1 Date/ /9g6
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