1986, 10-22 Permit App: 00013784 Garage, Carport (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 ' T MI
s i t
Project Address(Street Name&Number) Zip
AP i/ O/7, r .''P /d( 'PS G"v O
Applicant Addr:.s
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Zip Phone
Business Phone
Le—
Contractor Agen Address
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State/ Zip Phone
Contac Lice e Number(Required) Business Phone
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Architect/Engineer / Address
City State Zip Phone
Contact Business Phone
Lender Address
City State Zip Phone
Res. Comm.
Describe Work
e... �_
Assessor`ParcettJumber Lot Block Plat Number
Pertinent File Numbers Zone Comp.Plan Census Tract
NumberWt)welling nits _= Number of Buildings
Lot Size(Sq.Ft./Acre)
Settradt Left Setback Right Sethi( Rear Se -cki
Show on Site Plan: Additional Information:
Lot Dimensions Landscaping
Existing Structures Drainage Plan
Proposed Improvements Hydrants �■■ I
Structure Setbacks Topography I
Easements Lighting ! } I
Septic System(s) Signage ) I ! I
I
Water Lines Shorelines I !
—
Sewer Lines Highwater Mark
Fences,Wells MININIMIll
Driveway(s) i
Right of Way Width(s) —i -- ! _ I I
Names of
Fronting Street I j-
Flanking Street I I I a I
Legal Description 1 ! + j �— —i!
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Date: ■.
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DEPARTMENTAL REVIEW
Cond.
Approved, Approval Hold
Environmental Health Permit Number le 0
9
W. 1101 College 0
Room 200
Planning/Zoning
❑ N.721 Jefferson
Permit Number
Engineers
❑ N.811 Jefferson
Utilities
0 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 is true,correct,legal,and binding.
Owner's Signature Date