1985, 11-27 Permit App: 00008932 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 ; ,j
Owner's Name LAST FIRST MI
K 6(AF,;✓So,4/ Lii w trrh/?' F
Project Address(Street Name&Number) Zip
G7/5- i i #'. k Sr d/c (JA `99a./)--
Applicant Address
City State Zip Phone
S (S0Ct ) 92cts72A?
Business Phone
( )
Contractor/Agent Address
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 .:- zl :. Comm.
7 :i 0
-Subdivision/Plat Nartme/S t Plat Number
Assessor Palrcel Number. tot Block Plat.Number
Pertinent File Numbers . Zone Comp.Pfau Census Tract
Number of Dwelling Units Number of B�siidingi Lot Size(Sq.Ft./Acre) /T epth i Frontage i
1140 100
Front Setback } Setback
jam' t Right Setback . ReerSetback Rt W Width
Additional t tier ,..SquareFootage
41)1.4
m Number of Bedrooms
'Building Technician Dote oup Type
DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
�} Environmental Health Application# �
W. 1101 College (0 f//v
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities l I
❑ N.811 Jefferson
Plan Review/Fire Prevention I I
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
111
❑ Fast Track/Special inspection Information
Project Representative I 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
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