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HomeMy WebLinkAbout1986, 08-01 Permit App: 00012440 Garage (THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PEASE 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 -1 Project Number Owner's Name LAST _9RST Mi C__ —,4,eTz e, K - Project Address(Street Name&Number) Zip /60(! c . a)e.6s/t/ Applicant Address C',ot-g-r Z1 �e L , _ /6 a/f , `les/ ; City ,.., State Zip Phone o/<'.�h e e;EAg 9 2 7 ,-.. ( ) '9,2 V D 3/2 Business Phone 2 l+ Contractor/Agent Address City l State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address y — City State Zip Phone ( ) Contact Business Phone ( 1 Lender ----��-...__ �—. Address ICity State I Zip Phone I ( Describe Work Res. /" Comm. r)e-Titc_It Erb (.33A-RAG. (2i X 30) Subdivision/Plat Name/Short Plat Number (_.thi L 'SL..E�( ,-jA - R IST 4Aisessor Parcel Number Lot Block Plat Number I n i Z ti —._ 2-110 it, 6 4- Pertinent File Numbers Zone 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 . ` RI W Width 5 5 Additional Information ti Square Footage Z o2 0 z esz . k: 0 m Number of Bedrooms y Data GroupTYPe., 6v ... • t-11-- I DEPARTMENTAL REVIEW co,d. Approved Hold Appro,.1 Environmental Health Application# �CT+U � ,' tfoth.: W. 1101 College Room 200 d clyziceLe.f14 .A.e.21(itio Mr_ 14.14,1-447/..) 1,13 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.) 0 ❑ 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 unSite Phn� Additional A. L�Dim�o�� Landscaping Existing Structures Drainage Plan • Proposed Improvements Hydrants | '• | 0kuotumSethuoko Topography Easements Lighting --�- / Septic System(o) Signage | Water Lines Shorelines Sewer Lines Highwuter/NurA Fences,Wells Driveway(s) 4~ ' Right o/VVoyV0�h�) '� Names of •• Fronting Street / -��-�-T� Flanking Street � | ' | -- | ' | | � ^ > � , r-------4r � 1 1 U Legal Descript _ ,. , _. - , . , , , , -ion 1) � -�, ' '� --- m � 1--miiiiii,triiii.ol I ,____ _..._.4 _I: t____ LI ; ! - • 0 .tit i 41141 imis � . • ' I | ' � / "w ' | | / ' ���0 � � / | -�| " ( ' / | / � ---' / ` | / . __ _ / ' � � ' | / "- � ^` | I -- / MINN | | | ' | 1-- | � / � | � � | | �� / | l ' � | / | � � F ' ' }1 ' ' � r / / | / | � � / � | | ! / / | ,, / w � / | | � | | | �� / / / - _ ,� | | | | ' � | | | | | / / ��" ) H � � | � |• / -~- ' ' / | | | | ' ' | | � � | / � � | | / � | � | � | | | | | | | � iiiiiiiiiiNii -| | �� | ' | f ' � �[ | | | 1 | / 'MIN11- - � 4:?..i- : � - ! �--| -- --f | I gl- | ' | / | � r � | | i -_ ��'~ | ' ' | .Smhx -- 3 ' ~�7-' } iIMMO | i ��'-- ' |---� i- | --� { -�N�/ � ----! f / ' MIMI | ' | | } | ! | | | | | | | / ��� | / Date: | � / / / { ~�~� ' / ' I | --- � � ! ' i ' / Revisions: Attachments: | i | I � | / / i /INIMM��� � -] -| / 1 i --- - | --f --' ---� -- � | | | | | / / / ' | | / � | | / ' � / ' 4 [ | � / / . � ' � } / / ' ' � i | | | ! . � / / . / / / / | | | | , . „,„