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1986, 09-08 Permit App: 00013001 Garage
(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 /3cc 7 E 8 S'eAatuQ 75%;.-0 Applicant Address City State Zip Phone III Business Phone ( ) Cont for/Agent / Address �S `J,br t2 s�-e,,¢( EcJ. f is' ( 3��"d/ /rae4 Cit State Zip Phone Aum u.)4 61s') oS/S Contact License Number(Required) Business Phone ,4c -MSBAs Architect/Engineer Address City State Zip Phone Contact Business Phone Lender Address City State Zip Phone Describe Work Res " Comm. OE- -A-C Cao X367) Subdivision/Plat Name /Shorrt Plat Number ► 6�Q1©W S Assessor Parcel Number Lot Block Plat Number 225I/2 2fnG (o f Pertinent File Numbers Zone ee, , - Comp.Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft/Acre) Depth Frontage Front Setback I Left Setback Right Setback E Rear Setback STI 1 15 Additional Information Square Footage w D z w I— _ a 0 w 0 Building Technician Date Group iType QM-el 4-6 - 3 14-4- n) DEPARTMENTAL REVIEW Cond. Hold Approval Environmental Health Permit NumberO(S Approved W. 1101 College Room 200 \ ' Planning/Zoning ❑ N.721 Jefferson Permit Number 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 age, true,correct,legal,and binding. ,. iZ- rte' "` r"'"'`Y",,•? Owner's Signature - " Date Show on Site Plan: Additional Information: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark