1986, 11-12 Permit App: 00014191 Storage (THIS IS NOTA PERMIT) •
BUILDING PERMIT 4PPLICATION 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 W
1njectNumber
Owner's Name LAST FIRST
4 U L L AAELVI/1I 7/‘4 G I-/ S
Project Address(Street Name&Number) /5..6
q 1L Zip ! /
. /z / "/ 2./
Applicant Address
City State Zip Phone q 2 S yJ cil3
Business Phone sr:3 -9 7g
Contractor/Agent Address
.‘ S444
City 'State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
A/( JLViiv W. at,LL E /ci_Co L{ 7/6A
City Zi Phone ^ ^
v( o WA . 9 6 ( ) (7, 7 iQ 9
Contact Business Phone ) 53 s 9 ?S C
Lender Address
City State Zip Phone
(
Describe Work Comm.
,,rr
Subdivision/Plat Name/Short Plat Number
Vel
Assessor Parcel Number Lot Block Plat Number
5. 2-- cal -7 Z
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
`2--- 12702- 1•ft•(,, 8 7
Front Setback I Left Setback 1 Right Setback Rear Setback tt 13/1,NWidth
Additional Information Square Footage
22.3`0 z
O
F
Q
t re
2
0
aL _
_Z
Z
5
J_
5
CO Number of Bedrooms
Building Technicians, Date Group T
- Y j� i2.86 iVV- .t
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S
DEPARTMENTAL REVIEW
tlk. Cond.
Approved Hold
Approval
P.
)4
Environmental Health Application# (� i •'
W.1101 College .ItT)1^'---•)
r
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities I
El 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 to compile said application is true and correct.
Signature Date
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