1986, 05-20 Permit App: 00011495 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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number I
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Owner's Name AST FIRST MI
2.,..
Project Address(Street Name&Numbed Zip
EAST ,1glI 3O7ff AVE. CY-S2O
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Applicant Address
,r 7 /eze -- A) _ // .2- ,`- -:"
City State Zip Phone
L___51,0 A-. &/ s 4 9 y ,,_ a,^ (meg' ��V 6d fr
Business P(
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Contractor/Agent Address
City State Zip Phone
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Contact License Number(Required Business Phone
A" I- ( I
Architect/Engineer ' 5 67 Address
City State Zip Phone
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Contact J Business Phone
Lender ' Address �"u
City State r Zip Phone
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Describe Work - Res.✓� Comm.
#. ,f ou(l U) / -A ?4c
Subdivision/Plat Name/Short Plat Number
24.,-1)/<'0 Pa I poi&I5 t Tt
Assessor Parcel Number , (7 Lot Block Plat Number
se5 -- , , .._ a/ ao,�-a),, `1-
Pertinent File Numbers ` Zone Comp.Plan Census Tract
�' .,. .5.1.--eV. t ) �45t,c8
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
I
Front SetbackLeft Setback Right Setback Rear Setback R/W Width
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Additional Information Square Footage
sfoge As -, /1. l = Hp'
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m Number of Bedrooms
Building Technician Date Group Type
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DEPARTMENTAL REVIEW
Cond.
�J Approved Approval Hold
Q`C '
Environmental Health Application# C� t233 1% ,0426
❑ W. 1101 College +1 NiL
Room 200
, 1 ct� �.
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Planning/Zoning
❑ N.721 Jefferson
M;Zel
Engineers �l�o�J t'/
IDN.811 Jefferson , %
Utilities I
El N.811 Jefferson
Plan Review/Fire Prevention
N.811 Jefferson
,tjataet. (1?'"e-ov cio c y >
Other(SEPA/Critical Material/etc.)
0
o 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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