1986, 10-10 Permit App: 00013692 Garage -alp
4
(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
Project Number /..qe)4.,1._
Owner's Name --., LAST F ST
KAC.0 E T7A kl1 MI
1 PN
Project Address(Street Name&Number) Zip
EAST Cofos i2 r# 4v� Q92i2
Applicant/, Address
I<)4 1.-PP k 4A-C.071-1E-1-TA r . 6 16 s /2'7143
City �V 1410� State�'� Zip Phone
q qr « (5D ) 5- 7/- q '7 3
Business Phone
( )
Contractor/Agent Address
City State -Zip Phone
( 1
Contact License Number(Required) Business Phone
( 1
Architect/Engineer .�.�.e.�......_...._
Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender
Address - -
City State - ---
ZIP Phone
( )
Describe Work Res. Comm.
C)E: *gin CA PAGFCis K11 )
Subdivision/Plat Name/Short PI t Number
TZ--__ E,--r-r-14A0 sow
Assessor Parcel Number Lot Block tit Plat Number
Pertinent File Numbers Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
2. Boon ,35
en
Front Setback - Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
4,:r-( 7'
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2
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0
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to Number of Bedrooms
Building Technician DateGroup Type
-
/6- D- I 4.-, . vau
DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
(7...-‘Environmental Health Application I
W.1101 College
Room 200 L.
'�—�'Ct-c. vv--fl—m 5 a(-, '! Vi.. " ---4-)e__ c3ot ''. )
Planning/Zoning •* IIt)/IO/è
4---'
El N.721 Jefferson C)V t`'�2 cc-2-.0 v'`-=F C3 �' ��
71c,.k. de&er S4 c iv , six
L
•� �r .:ate_ `t/ I
tlir;I
7j/0 111:001e (1.6 1).1 7
e(/ Engineers
NJ N.811 Jefferson
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
0
o 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
f
Show on Site Plan: Additional Information: i ! I ! , ' ( 'r (1iiiii
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Lot Dimensions Landscaping _1I I i ! -__f f ,__ _ _._
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Existing Structures Drainage Plan i .1. I
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Proposed Improvements Hydrants I MI= ± 1 ! I ; , ! I ! 4 j
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Structure Setbacks Topography Itiliti
tall
Easements Lighting
Septic System(s) Signage a i ! HHr
Ses I Highwater Mark - ___� _
1
Fences,Wells Millh= I I 1 i ( ',C
Driveway(s) I I I ,..r e
Right of Way Widths t- ' 111
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Names of I j ~— _i - ...
FrontingrtI I 12111
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Street —t ( R+li i
Flanking Street �- I — 1 _, [�� - r -
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Legal Description ....T ; — _ ! ! I �I
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