1986, 12-05 Permit App: 00014435 Garage (THIS IS MOT 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
I Project Number t�-
'ily'� !
Owner's Name LAST FIRST C MI J J
Project Address(Street Name&Number) Zip
._if/ o 3— //71y . 5.)0,0,61-it ��O'�)D
Applicant Address
,54/41e
City
54/41Y_._-
City State Zip Phone
Business Phone
(sal ) 76:2.$— a.ec y.S`_
Contractor/Agent Address
,_,Sr*,--/1?.e•
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State I Zip Phone
I ( I
Contact Business Phone
( )
Lender Address
City State I Zip Phone
( )
�] �^ }� /� �/))��/��ll Res. Comm.
Describe Work + T N E D 36 IIYv! �/
Subdivision!Pla%,Na IshortPlatNumber '
A t �/ALil-G>' App
Assessor Parcel Number Lot Block Plat Number
Pertinent File Numbe,Ps Zonet Comp.,Plan us Tract _
Number of Ovrelling nits Plumber of Buildings
_ ,- Lot Size(Sq.Ft./Acre) Depth Frontage r
� lam--
1.38 , ?�.. .. . _
Front Setback e' , Left Setback ,rt Right Setback Rear Sett ack
, y;itti t i.-
Additional lnformatlon 'Squarg Footage
w
Z
w
M
Crw
Building T Date_ �", . n+ ��,`^-, �.�
DEPARTMENTAL REVIEW'
Cond.Approval Approved Hold
Environmental Health Permit Number
❑ W. 1101 College Ei�
Room 200 SE-1.0
Planning/Zoning
❑ N.721 Jefferson
Permit Number
Engineers
❑ N.811 Jefferson
Utilities
❑ 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 is true,correct,legal,and binding.
Owner's Signature Date
I1/11 tj
` y
s
*(st .'/71
Lai- B1�ck( 3 D p h�
Ap1ok o¢lle y it d6'
htair
El3 ! — yo�
--u
ft,
30/I -