1986, 10-27 Permit App: 00013858 Garage Addition 1 _ _
(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
Owne 's Name LAST FIRST MI
•oject Address(Street Name&Number) Zip
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Applicant Address
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City State Zip Phone
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Business Phone
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Contractor/Agent ` Address
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City State Zip Phone
o�l e•-"-G"-7 _ q5 ) 42. r- 304
Contact License Number(Required) Business Phone
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Architect/Engineer /S8 /S ? Address
City State Zip Phone
Contact Business Phone
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Lender Address
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City State Zip Phone
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Describe work Res. Comm_
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number Lot , Block Plat Number
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Pertinent File NumbersZon
Comp.Plan Census Tract
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Number of Dwelling Units Number of Buildings (;Size(Sq.Ft./Acre) Depth Frontage
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
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m Number of Bedrooms
Building Technician Date Group Type
DEPARTMENTAL REVIEW
Approved CpApproval Hold
Environmental Health Application#
❑ W. 1101 College
Room 200
Planning/Zoning
O N.721 Jefferson
Engineers
O N.811 Jefferson
Utilities
O 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: ,, —
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Lot Dimensions Landscaping \ 1
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Existing Structures Drainage Plan .
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Proposed Improvements Hydrants —4------- -_--. - -- 4, .-- i- ---
Structure Setbacks Topography
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Easements Lighting - , ' 1
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Septic System(s) Signage _ . . , •
Water Lines Shorelines
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Sewer Lines Highwater Mark • . • :
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Fences,Wells ,
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Driveway(s)
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Right of Way Width(s) _ . , , , -. , , , ...
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Names of
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Fronting Street
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Revisions: Attachments:
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