1986, 05-27 Permit App: 00011221 Garage •
•
• (THIS IS NOTA PERMIT) - : •
F3UiLDING 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
Pro)ect Number.,
Owner's Name LAST FIRST MI
_tiewn/_/:
Project Address(Street Name&Number) Z:p
E 73/2 /D �y7 J/O. u//l qqz/z
Applicant Address
S,g44E £ 73/2 / 0 r_AZ
City State Zip Phone
cc �0/N WA 99 Z i Z (s-em qz — yp
Business Phone
(5o9) 9'z8 - 6/5/9
Contractor/Agent Address
S 4, f4,446
City State Zip Phone
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State Zip Phone
Contact Business Phone
l )
Lender Address
City State [Zip
Phone
Describe Work Res. Comm.
A-3,Ae0E.t) "Atm GE(24 X30)
Subdivision/Plat Name/Short Plat Number
a)04V LAU [D I Al2k
Assessor Parcel Number Lot • Block Plat Number
2134--- to-7
Pertinent File Numbers ZoneAasComp.Plan Census Tract
� _
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
I/ 3 '�
Front Setback • Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
7
Z
O
H
2
O
U-
2
C7
2
J_
5
00 Number of Bedrooms
Building Technician Date Group Type .
r�;3 _ . ., f.; _ r l '— VKJ
Show on Site Plan:
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)
Ramos of
Fronting Street
Flanking Street
Legal Descrption
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
DEPARTMENTAL REVIEW r b Oqo
Cond.
Approved Hold
Approval
Environmental Health Application# ) l9 ���
W. 1101 College
Room 200 777``t
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention S
N.811 Jefferson
Other(SEPA/Critical Material/etc.)
❑ Fast Track/Special Inspection Information
Project Representative Phone
I Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my gent tompile aid ap lication is true and correct.
Signature Date