HomeMy WebLinkAbout1985, 12-13 Permit App: 00009167 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 1 plojar.
4.
Owner's Name '\- -- LAST FIRST M
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Project Address(Street Name&Number) \ ^ Zip
Applicant. _ Address
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City State Zip Phone
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Business Phone
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 C Address
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City State Zip Phone
Contact Business Phone
( )
Lender Address
City State I Zip Phone
( )
Describe Work ,°,4;t7i:H-:-•'.'!/::.-:'!i';:47:,:,, 74,:;:=::. )*6▪ ', ',e7... .,..,,i ,.,, ::
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Subdivision(Plat'N !Shot Plat Ntber
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Assessor Parcel Number , Bloch Pim Wumber
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Pertinent File Numbers.
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Number of Dwelling Units Number of din▪gs Lofts(Sq Ft./Aare) pep,* Frontage
Front Setback r f s� '' tSetback Fede R/W Y idth
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Additional Information /Square Fie
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1, i+umbe of-Bedrooms
Building Technician ''Date Groiup Type
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
46
Environmental Health Application
W.1101 College WS-
Room 200
Planning/Zoning
0 N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention C'
❑ N.811 Jefferson PH 3-
Other(SEPA/Critical Material/etc.)
❑ 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 a••lication is true and correct.
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Signature)1C-15 )-------
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