1986, 04-22 Permit App: 00010797 Garage 7I
,. ...
(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 Protect Number to-7 6 j
Owner's Name LAST FIRST MI l j
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Project Addr s(Street Name&Number) Zip
/ 3 0 , '-‘::: e'- ' 4i,"i , s O moi, , er //‘'
Applicant Address ���J
Cl'%^y �r i; /7-5, /3 %°'`/ • ':--t6'14-- I'
City State Zip Phone
Business Phone
( ) ---7-79-- Oc/Q/
Contractor/Agent Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State I Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
(
Describe Work Res. Comm.I CAN NI \. ?t`:. 7�‹- 4 C,) / f. 2 k�(4 �.(!2x.- -,-‘._.) - (ej/C 7,4)
Subdivision/Plat Name/Short Plat Number
PAjit e 6'.11 E�.:LC.. .5. fI L7 0 .. •
Assessor Parcel Number Lot Block Plat Number
` --3C) -{ I - Cl_l`-
IPertinent File Numbers Zone E Comp.Plan Census Tract I
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Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
�_.. t4 1 7S/
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
2
O
. 4' -13.5- P
2
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ti
z
Z
0
Oa Number of Bedrooms
-
Building Technician Date J Group Ty
DEPARTMENTAL REVIEW
Cond.
Approved Hold
Approval
0{ a
Environmental Health Application# 4 i s
,‘1.
W.1101 College ( \`
Room 200
1
Pianningi :onir.g I
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities ; I
❑ 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.
Signature Date