1986, 09-25 Permit App: 00013295 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
Project Number
Owner's Name LAST FIRST MI
51�K j: 70,j. Fra el C ;S.
Project Address(Street Name&Number) Zip
Ian -7 12'4F. 12- t frue
Applicant Address
City State Zip Phone
( )
Business Phone
( )
Contractor/Agent Address
4a 'IS k9te- .—S774-44,, 'IQ.'i'. _ g y o fE., /re" l'L
City State Zip Phone
>,"D ko.4of Ce...-Aft- 9)0U ems-- ,cis )es-t
Contact License Number(Required) Business Phone
Lc k- 41SI - 10 MS. ( ) So-.c.o.
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone ------71.
( )
Describe Work Res. Comm. e
g
Subdivision/Plat Name/Short Plat Number
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_____..1
Assessor Parcel Number Lot Block Plat Number
2--.1 1 8 1
CJ
' Pertinent File Numbers ( Zone �0 Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings I Lot Size(Sq.Ft./Acre) I Depth i Frontage `
ti r 1 1 ?); ! SBo
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information 1 Square Footage
7
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m Number of Bedrooms
Building-Technician Date Group Type
DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Application#
0 W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers //,,/ /�Gr� '/ �!
N.811 Jefferson iS7h 4' ! Pa 0`t 7
Utilities I
CI 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
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Show on Site Plan: Additional Information: , t ---"t----.-- • . .4 ----r---4— r.._t_t_ ,
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Lot Dimensions Landscaping . 1 ; ,
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Existing Structures Drainage Plan ,
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Proposed Improvements Hydrants 1
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Structure Setbacks Topography
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Easements Lighting . 4________________,___, ________
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Water Lines Shorelines .
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Names of
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Fronting Street
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Legal Description
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