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1986, 10-06 Permit App: 00013485 Garage s qI• (THIS IS NOT A 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 i31�Q5 Owner's Name LAST FIRST MI W hYY�� Po+orof C1�ti14 Project Address(Street Name&Number) �� Zip C , lk�o y 7__6 /-- Qq�--1 - , Applican Add Jess ', City State Zip Phone ( ) Business Phone ( ) Contraileri Agent Address V City __// State Zip Phone C! y% ICom( qq ,) ( ) qz7, s---c Contact 4•0 ., License Number(Required) Business Phone Se& 1 S !“ * C8 ( ) )., Architect/Engineer Address City State I Zip Phone ( ) Contact Business Phone ( ) Lender Address City State I Zip Phone ( ) Describe Work Res. Comm. Subdivision/Plat Name Short Plat Number m„, -- t'e”Vi'a. Ir`kft4,..)5/7-- - Assessor J5/TEAssessor Parcel Number Lot Block Plat Number • 5 '% '- F".2,_,), 1 51(0 3 Pertinent File Numbers ZoneComp.Plan Census Tract I�(1.Su$ Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage ,. ,- /30 /©D front Setback I Left Setback Right Setback Rear Setback R/W Width- Additional information Square Footage m 44 z 0 F 2 'r �✓ 'rr ' 0 r ` - U- ag f.*., 0 0 —I m Number of Bedrooms Building Technloi Date Group Type DEPARTMENTAL REVIEW Approved Cond. Approval Hold Environmental Health Application# ❑ W.1101 College Room 200 " Planning/Zoning ❑ N.721 Jefferson Engineers ❑ N.811 Jefferson Utilities ❑ 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 o 0 0 0 -- I-- -c " L • ; I 1 gym— �- — 1 • • ^I 1. 11 pt � ` -t 1 1 I tis--�'\ - + •.�_ ..... "_T- - irI _L4: iA . E i Li .. .....7,1-7-1 +— T i } • �i ' _ I E t • — T�_ T L 1 i_ t __} __1 { / N p ?riN7relD ENCSRSS _ -- -----t- _ ' -- --�FI OP6 t/30 • j { Ter .10--------i--.---- } i - --- ti t ......4.___------- i- f a i_ . _ .._ - - -1. : t 1 — • — t, •. - t OM t T ( } ' 1}} : ._ r�: I 1 ' r` i : y� 1 • — , t I ice) x�Mo ToN zTr — i }( -..i___. � f-0 -7 (1 . . --.. E