1987, 07-13 Permit App: 87002150 Addition (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
I Project Number
Owner's Name LAST FIRST MI
Project Address(Street Name&Number) Zip
Applicant ] Address
7 )i, -P,Y1 t/2' L
City j State kik.- A Zip Phone
Business Phone
( )
Contractor/Agent Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( I
Lender Address
City I State Zip Phone
- ( )
Describe Work Res. Comm.
Subdivision/Plat Name/Short Plat Number - -
PC,R ."\--Ct(Vi-
Assessor Parcel Number Lot Block Plat Number
.j-`. 44 \ 130 (7j _ •
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 R/Wth i
---- C?
Additional Information - - , Square Footage
r'F,
- - Z
0
F
cc
i��' ._ - __. u_ _ _—
Z
_ Z
a
J_
5
m Number of Bedrooms
Building Technician . n n Date Group T•,
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Widths)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
,-
1
Scale•
Date:
Revisions:
r
Attachment%:
4
,
,t,___ _i
:
4
.
.
_i_
ti L-- -----
, I
-, ; , -
_,
4
1 ,
, - .
i...„..._
... _ .
-
1
• n
Min
111111
IL;
M
i _
._.
t i
,
ill
r-
MM.
--
-.
II MEM
1 ...
Ian
'
fr
I
.
:
11111
:
, .
UM
MIMI
irIIII
mil
...
.,.
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application M
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
.
Utilities
N. 811 Jefferson.
I
1
_ .
• ,.
•...,
..
Plan Revlew/FirePrevention)
N. 811 Jefferson
V rt
Other (SEPA/Critieal Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
1 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
3
MEM ME
111111111
1MEEi�op
■■ NL�IiN
t
..� N1111�■■N
NEE
upo m
1111111111111111
IEEE
■■11!11■N!■■■
■111!11■1 11■1111111111■■R#
Ell ■■■■■.■■.1NN■■
111,■ ■■■..■■■.■.■■■■�N■.. ■.....■Nr■.
�il ! iN11 rim.
AHEM ■1.=1111111111!■1!.11
MEE�"■1 �■ 1111l111■1!■'I' ■
�■■ �■ ■■■■..u.. ■.
uiiiniiil mi Illllluiuuuuii
■■■.■■.■. =A lE;177■.■■ ■■■■■■NNN■
N"""�' ■1 ! 1111111■ mumm
■■■■ ■■■■ ■■■ i. _ r�■ ■■■■■■■■■■■NN■■
/1111111 __II �ili11111111! i�r�l
w■..■■■�■�■N■IL��■■■■■■■■■ NNN■■■
■111!11.1 ■1�■■1!1!111.11■M■!
■111!11■1 ■1�■l1111111■11■■■!
1
4411 Mit