HomeMy WebLinkAbout1986, 11-18 Permit App: 87000436 Relocate Residence (THIS IS NOT A 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
Owner's Name LAST FIRST MI
Project Address(Street Name&Number) Zip
APPlicanJ 1 Address
r .I }} �G .r .7r`7 >�=-—>•4-30-3 Z-- 72.4i City�r,^G� / State C� Zip . 3 7 Phone (5-0
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Business Phone
( )
Contracto ,AgentAddress
�, s.' 2 . f. �3 i-6.73 Z .3 1 � '‘
City State Zip Phone
Z_..--/----/?--,---.10.25./ /—z-2/ ,',D37 (s- ,") ,c'. z z_j
Contact License Number(Required) Business Phone
C74 zea 9rS I ) ,7
Architect)Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
Describe Work Res. Comm.
r ..o(+A`tom itsioes.1 CO !amu LL 8LSEMnkir
Subdivision/Plat Name/Short PI t Number
' PaE 3E20
Assessor Parcel Number Lot Block Plat Number
Ill 5G 1 — 1161 tI I
Pertinent File Numbers Zone
Comp.Plan Census Tract
e
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Front Setback Left Setback Right Setback Rear Se RI W Width
ir> lb /0
Additional Information Square Footage
rEt_oeArtCsJ .11 o
EASGEour G2'. SSD Z
Q
"'fit o0 A fi R2 PO o
14.Z
a
Z
0
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5
m Number of Bedrooms
Building Technician Date Group Type
sr;. 4 -1 II—IS—Se 3
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DEPARTMENTAL REVIEW
Cond.
Approved Hold
`/ q6
Approval
2( Environmental Health Application 0
W.1101 College
Room 200
G
_,/Planning/Zoning '
u N.721 Jefferson92freldij
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N.811 Jefferso _ I �' �
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Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
D 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.
SignaturAk --' Date
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