1986, 06-24 Permit App: 00011771 Relocate Shop (T 'IS IS NOTA PERMIT)
BUILDING PERIV11T 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
lieR M i
V��efesvvt
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Project Address(Street Name&Number) Zip
1300 F xif6 ,5f c,
Applicant Address
fir^-► {� e e �s r _ r 3 00'7 C 56141
City State Zip Phone
c.)1<itc,e— i.AJQ °I`( -2/C ` ) 2.4 —S 7_
Business Phone
Contractor/Agent ti Address
City State Zip Phone
Contact License Number(Required) Business Phone
t )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( 1
Lender Address
City State I Zip Phone
Describe Work Res. Comm.
( re Ho P(241 K96) Fen-7 kJa ✓
Subdivision/Plat Namei.ShortPlat Number
aP-rei,c 4 `-1
Assessor Parcel Number Lot Block Plat Number
V
Pertinent Fife Numbers Zone Comp.Plan Census Tract
AGSU6
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
3 / /82
Front Setback Left Setback Right Setback Rear Setback R/W Width
/1 S T//UCs► 25
Additional Information Square Footage
t _ t
0
0
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m Number of Bedrooms
IldingTechnician Date
Group Type
DEPARTMENTAL REVIEW
Cond.Approved Hold
Approval
Environmental Health Application I •
W.1101 College •
Room 200 „ ( /
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.)
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.
.a c
Z1
Signature Date CD a 7 TJ
11
Show on Site Plan: Additional Information: I '• I ,
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Lot Dimensions
Landscaping , 1 I #- { �..__ �.._
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Existing Structures --r ' --'-_ •• -�--+-
g Drainage Plan 6 lei,._
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Proposed Improvements Hydrants t , • _ __ �..
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Easements
Lighting
Septic System s Signage I �- i
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Water Lines Shorelines I __ _ _ —_ __ t - -L I
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Sewer Lines Highwater Mark __.� -__�_ I i I - 1
Fences,Wells ' i i
Driveway(s)
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Right of Way Width(s) _._ ,- 1 . :.__.._ -_ i __ __ _ -__
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Names of -T
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Fronting Street __. -__j
Flanking1\ -
Street
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