1985, 10-31 Permit App: 00008452 Storage Bldg r
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(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
HADandED yourAREAS buildingAREFOR plans toDEPARTMENTAL the DepartmentUSE of Building and*140S )i
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Owner Nam LAST FIRST MI
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Pwoj t A dress(S eet Name&Number) Zip
Applicant Address
Zip
V.fift.r.k.6edici2€ Stat/`( //1 // �F Phone LV 1 !U 7
_[ Business Phone
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Contractor/Agent Address
City State Zip Phone
( 1
Contact License Number(Required) Business Phone
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Architect/Engineer Address
City ' State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State I Zip Phone
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Describe Work
Subdivision/Plat Name/ShortPlat N mber
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Assessor Parcel Number lot ock j',' f Number
Pertinent File Numbs ' �T
Cup Platt
Number of Dwelling Units #sumo*,47#!!! ,d,15#1.. s Ft:/R3 ? . 15th
Front Setback Left a t'
1. t`�t 4. r 5slb� ( Fl Ytttk
Additional Information " c, c �� h
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1D Nuitt?be of Bedrooms
Building Technics Date Group Tyles
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DEPARTMENTAL REVIEW
Approved pp
Apprrovov al Hold
�{ Environmental Health Application# ____1(0. OOz ! fS
l� W. 1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities I
E N.811 Jefferson
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Plan Review/Fire Prevention
N.811 Jefferson 917/r
Other(SEPA/Critical Material/etc.)
❑ Fast Track/Special Inspection Information
Project Representative Phone
Address
I certify th- I have xamined this -•• I - 'on and state that the information contained in it and submitted
by me or m agefr{t t. ompile said .•plication is true and correct.
MOSignature
1 0 A✓ Date 10 - 3/ - 6 S^
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Name
— — --- Setbacks & Existing or Proposed
DETAILED Legal Des. The N5.0 acres of Traci; - PLAN
Easements. Location & Dimensions
217 of Vera, accordin t-o p lats, Pg 30, EX-C
SITE , — g MUST of Lot Lines, Proposed Buildings,
East 125 thereof __ __
PLAN SHOW Roads, Sewage Disposal & Other
Total Sq.Ft.or Acreage
, Utility Services.
Scale 1" = 20' or l = 40' ` )
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The information shown and the statements I have made are correct.
Applicant Signature _ Date
For Offical Use Only Zoning(I
Permit# Accepted By
Reviewed BY Planning Commission Health Dist. Build. Dept. Assessor
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NOTE: DETAILED PLANS SHOWING THE SAME INFORMATION MAY BE SUBSTITUTED FOR TNTS FORM