1986, 09-30 Permit App: 00013360 Garage (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
Project Number
Owner'jille LAST FIRST MI
/ 6//e/7 OtA)est r(Y
Project Address(Street Name 8.Number) Zip
Applicant 1 Address
Cityv.‘ J�, tf �� 1�A(A•` (t f.�-�"s er ,�C d '* i'e(et i4.44
State Zip Phone
3P ( ) 90/ 11,o) ,-?
Business Phone
( )
Contractor/Agent Address
..
?9.?1 ra.Lam .,
City.5e
State Zip Phone
Con License Number(Required) Business Phone
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
Lender
Address
City State Zip Phone
Describe Work Res. Comm.
CM Z Ptiz.ACi C lk "7-
Subdivision/Plat Name/Short Plat Number,
i d D tP)tA) o� t / � IC--
Assessor Parcel Number Lot Block Plat Number
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
i
Front Setback Left Setback Right Setback Rear Setback R/W Width
,- sA.)6, rte, rte ,,
Additional Information Square Footage
Z
0
I-
2
O
u.
z
is
Z_
0
J
5
co Number of Bedrooms
Liiiding Technician, {I Cate / / Group Type
P1"'C.
DEPARTMENTAL REVIEW
Hold
Approved
Approval Environmental Health Application N Appr
r'
W.1101 College F
Room 200taidd_
Planning/Zoning
D N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
Q 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 agent to compile said application is true and correct.
Signature Date
1
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