1986, 10-13 Permit App: 00013573 Storage Bldg (THIS IS NOTA i'ERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTSOF r
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 / -+
........._„..-51PST. MI
Project Address(Street Name&Number) / 5 Zip
5— 3 05 /z- '� r/—"""ir. .1cs-.24 Cv_.e.2/¢ Y -°'37
Applicant
L 7`-1 Address
Cit J State Zip Phone
r"-.F w /4 ,So32 (5-D, ) 9zz -zzz7
Business Phone
( I • t
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frac /Agent - -
Address
C.--. 9 • '../ '71
o '-t..) .. ---.7.7-.- ..5" 3 Z
3 iz_ 7'C'
City 'State Zip P Phone
Z.---2"•••"--5...--1-, ��X . ,� _ 9S a3 7 _ (3----67 ) ,2_0___ z_z--z_ 7 .
Contact License Number(Required) Business Phone
fin - L op/4 ZE-3 c p Z I I )1
Architect/Engineer ____- Address
City State I Zip I Phone
I ( )
Contact Business Phone
i ( )
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Lender - - - — Address
City State I Zip Phone
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Describe Work
Res. Comm.
' ,; \ ; (_\ r--....„' D, Y-, ` 405 x 2E)
Subdivision/Plat Name/Short Plat Number
`E V rte-^
Assessor Parcel Number Lot Block Plat Number
235itik -lois,
Pertinent File Numbers Zone Comp.Plan Census Tract
1
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) �A Depth Frontage
2'30
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information tSquare Footage
Lo car E-T2 rRoM 5 t/500 d-Trii PD fioo "0
Clo H/4- e-t-O @Loe I-/4uS A-12&44.
z
0
-W14-4"re- S TEC L Cid i.-0 s t be OF- Q
2
12a�. y 2
z
.- . -
- m- Number of Bedrooms
to Technidah Date
�; re .kms I Group Type
."-ante
DEPARTMENTAL REVIEW
Cond.
Approved
Approval
Hold
Environmental Health Application fi
❑ W. 1101 College
Room 200
Planning/Zoning
❑ N. 721 Jefferson
, ngineers / -• .1-6
IV N.811 Jefferson ✓ii
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
0
❑ 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.
Signatu •••- Date / 3
Show on Site Plan: Additional Information:
Lot Dimensions Landscaping
_-- - .
1-- - _
Existing Structures Drainage Plan
Proposed improvements Hydrants ---- _ -_ ____ :__-
Structure Setbacks Topography ! __ _._ r > .____
Easements Lighting }-_ } {._
•
Septic System(s) Signage , ; ! _._ ,
Water Lines Shorelines i
Sewer Lines Highwater Mark __.
Fences,Wells i
_ -
Oriveway(s) t, — _
Right of Way Width(s) ..--
Names of
Fronting Street
Flanking Street /'1,
. I
�_
t-- - - . i , _____
Legal Description
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