1986, 02-06 Permit App: 00009631 Garage (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
I Project Number
Owner's Name LAST FIRST MI
"71%`1flo
Project Address(Street Name&Number) Zip
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Applicant Address
City State Zip Phone
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Business Phone
( )
Contractor/Agent Address
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City State Zip Phone
?/)k , y .} I . ) e 63.< !;!e"-/I--
Contact License Number(Required) Business Phone
AO�s 'r� 5 iSj_ ,-�, I ( )
Architect/Engineer Address
City State Zip Phone
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11 Contact Business Phone
( )
Lender Address
City State Zip Phone
Describe Work 'Res. / Comm.
Subdivision!Plat Name/Short Plat Number
1.FF(:��.f f`3 e 'J
Assessor Parcel Number Lot Block I Plat Number
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Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth 1 Frontage
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Front Setback I Left Setback Right Setback i Rear Setback
Additional Information Square Footage
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Building Technician Date Group Type
DEPARTMENTAL REVIEW
Approved CHold
�� Approval
Environmental Health Permit Number g cro
W. 1101 College
Room 200 V
J Ti rE's
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Plan Review/Fire Prevention I I I
❑ 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 is true,correct,legal,and binding.
Owner's Signature Date
•
Show on Site Plan: Additional Information: ; I I I I 1 , 1
Lot Dimensions Landscaping -
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Existing Structures Drainage Plan IIIIII■® I 4
Proposed Improvements Hydrants
Structure Setbacks Topography .
Easements Lighting — .._ I 1 I
Septic System(s) Signage — ■ ' `
Highwater Mark IIUJU!L
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Fences,Wells
Driveway(s) i i `is �,�
Right of Way Width(s)
Names of <
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Flanking Street j , I �_... -_..�
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Ji Legal Description } } _. } —
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Date: —
Revisions. Attachments: I I I I
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