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1986, 08-26 Permit App: 00012830 Garage t (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 1 r� Project Number 1 Flet 30 Owner's Name LAST FIRST MI V2=YSz t►v TO rte.) LA s ty Project Address(Street Name&Number) Zip _ Applicant Address kawtiC i City State Zip Phone K D ^7 ( ) Business Phone ( ) Contractor/Agent Address IA VA L� City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) ) Contact Business Phone ( Lender Address City State I Zip Phone ( Describe Work Res. Comm/; . :-, i\TT kC- C-•\--\-C,- c..) 6 A I? *-- CA-E- 6-Z.24--)<,24-7) ,. ivision/Plat Name/Short Plat Number ' •r Parcel Number Lot Block Plat Number 9. 5- LT-K67 ---7 1 anent File Numbers Zone Comp.Plan Census Tract ber of Dweili' its Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage , ?�� 8©` t Setback Left Setback i Right Setback Rear Setback R/W Width I .ditio nal Information Square Footage' /'7 4 7)7 z0 kQ cc . , ffa 0 LL _z o z a :t J 5 m Number of Bedrooms - Date j Group TY DEPARTMENTAL REVIEW Approved CpApproval Hold Environmental Health Application I ❑ W.1101 College Room 200 N o Co") €uc-T Planning/Zoning ❑ N.721 Jefferson Engineers ❑ N.811 Jefferson Utilities ❑ N.811 Jefferson Plan Review/Fire Prevention ❑ N.811 Jefferson ac-13_3 To D 73 9 c C t Nom'Pf c-T--k.9� t•-.Po th`wrv> 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 i I I C ( i • I I 1 j � j j I t t_ i } I I ! ' t I j 1 i ' 1 r , I r ' I r I , I } I 1 I Ii - t ---_- -_-_ __ Y - i t 1 1 I 7 1 i I i 1 j 1 ; > -.._4- t. 1 ,— — 1 I I t I I 13c,,► I i i '-r( I t rt I L .-- - I I . . — � I i { '-,- ! ; {- 1 -- 1 _ ' - - - E 3-33-43I _ II 1 i t _ I : I f t r T e I I 1 - - - —+ t 1 ; N 4 4I, -+ I - I — I 41 tt.i ark I i 1 r I fi I ! , _ i. 1 I_ a i 1 4- _ - , I r 1. I I I 3 I > 1 I I 1 I i 1 . . _ 1 11 I I rt I 1 1 —