1986, 05-08 Permit App: 00010922 Garage i
(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 [ProjectNumber '0�{�f 2
Owner's Name f�•
ST // .F M
L414/
Project Address(Street Name&Number) r`•,,/ ?6,‘ Zip
icAliope,
Applicant / / igie Addres� e4 06 9�1
City State Zip Phone
•A44 Gtr g9Z/2 +sag) .roS'ao
Business Phone
( )
Contractor/Agent
S Address
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( 1
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Address
Lender
City State Zip Phone
( )
!...4.:47„.`,4.1.4.6..., Res. n` Comm.
b '�4 34)
"-..',."6,-.AA r�; 6,� A ember
e`.
Lot Block Plat Number
�: t)22.165
° �� Zone Comp.Plan Census Tract
/ S(I 6
Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
? Left Setback: Right Setback Rear Setback R/W Width
, - — . L+ �—
J
Square Footage di
" _
rx
cr
o
u.
7
Z
g o
�, CO Number of Bedrooms ,
•
su Date ,
„„ �, � Group Type
w
DEPARTMENTAL REVIEW
Approved CHold
Approval1Wond.
Environmental Health Application# A ' ►I
W.1101 College -I.S4-86
J-
Room 200 it .S- —8o
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
[M Plan Review/Fire Prevention rJ
N.811 Jefferson M4SCAr DO
Other(SEPA/Critical Material/etc.)
0
L _
❑ 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 ppiication is true and corre
_ s ri�,
Signatur
-
i
i
I1
}
i
I.
4. - _ , , 1 1 , ,
I
t
.
r
I
i
i ,
,_ i
,
i-
•
1 - -� � r-T-1': ..
4 _ __ LL-_ _ f i ; .
t
T iFrr /7 7.
kE
i ?:, : 4 t
7 7 t
, t J1.
7
---1-1.-_.- _._.-.-- -_ - 1
B
t i rt I I i . , l , f }
; , I
l ,
i
:
,
I
I
ii I
i
,
1
I I
t t {
I 1 1 ,