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1985, 07-18 Permit App: 00006679 Residence(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) 0 IM -1 701 E1 0 DEPARTMENTAL REVIEW certify that I have examined this application and state that the information contained in it and submitted by me or my agent is true, correct, legal, and binding. Owner's Signature Date Approved Cond. Approval Hold vironmental Health Permit Number 1101 College m 200 FW. Planning/Zoning N. 721 Jefferson — Permit Number Engineers N. 811 Jefferson Utilities N. 811 Jefferson Plan Review/ Fire Prevention �1 N. 811 Jefferson ,1-c; (� Other (SEPA/ Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address certify that I have examined this application and state that the information contained in it and submitted by me or my agent is true, correct, legal, and binding. Owner's Signature Date FLAN NO. 500 ALT.- EL EVATlON r A eA iia I "l " I MD'3e;'fs,R� '�R r - - •av wary Lwc __ 3o rA Additional Information: Lot Dimensions Landscaping Existing Structures Drainage Plan Proposed Improvements Hydrants Structure Setbacks Topography Easements Lighting Septic System (s) Signage Water Lines Shorelines Sewer Lines Highwater Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Legal Description l U1 E— - - - - CMAI M F I E.L.D' 1 i �J a d00 LaAL. SEPT 14..TA 4W - i t 7e A WON 10 lc.' ct y1 F7-4, All Scale: Date: Revisions: Attachments: _ z