1986, 12-17 Permit App: 00014563 Garage iift-
rte` (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY'HOSE 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
Owner's Name LAST FIRST MI
DAvis .46---
Project Address(Street Name&Number) Zip
6- 3«a //11-4 ,441G— 47,2/4
Applicant Address
City State Zip Phone
( )
Business Phone
1 1
Contractor/Agent Address
B, x -R -57--E-6- 6-34as -Sp,e ,,,e-
City State Zip Phone
Spo%4nve---- C!/�-sh ?noa ISO? ) 5-3...5"--36 4 8'
Contact � License Number(Required) Business Phone
,fes . T.�-�el3E)? f42.. ----- 2--f T C.l I )
Architect/Eneer Address
City State I Zip Phone
I 1 1
Contact Business Phone
( 1
Lender Address
City State I Zip Phone
( )
Describe Work , Res. Comm.
BPonit it, �
Subdivision/PIaaName/Short Plat Number .
Assessor Parcel Number Lot Block Plat Number
. ,
Pertinent File Numbers , - . Zone ---- Comp. Census Tract
Number of Dwelling Units ` Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage- _ .__ -
Front Setback Left Setback Right Setback i Rear Setback
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Additional Information Sq __
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Btt`i(ding Technician Date Group ,YPe " ��
'- 7':m. 2 -Ir-ec m 1 v
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DEPARTMENTAL REVIEW
4
Cond.
Approved Approval Hold
fts$Q7c°Environmental Health Permit Number G c
/W. 1101 College (Room 200 . ' 4 1.
Planning/Zoning
❑ N.721 Jefferson
Engineers Permit Number
❑ N.811 Jefferson
Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
❑ Fast Track/Special Inspection Information
Project Representative Phone
Address
tr
I certify that I hay- a' fined this application and state that the information contained in it and submitted
by me or my agent /,correct,lei: 'd binding.
i /
Owr}eSignature e../L., ' _'IL/ Date _Ii;//f
154' J
1* ' sb
4-32'--
90' 41 61' ry
24' : n 'y,
y
1 27 -i► 2?,
Propose4G -
—}
5'
Lee Davis Plot Plan
Baker Steel Inc.