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1986, 07-10 Permit App: 00012042 Garage
(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 I Owner's Name LAST tf,t noel :::','' FIRST MI 'A.)1✓1 e I I I c Cr s4 ex.�t< h.lL . C_(�rel Project Address(Street Name&Numbed Zip /Ie© I p. &/y-t- i Applicant Address ctr/e_. //),,k-err e/- /44,?/ ... 3l�� City State Zip Phone t9,44/-7,2_ i/idsk Business Phone Contractor/Agent Address City State Zip Phone ( ) Contact License Number(Required) Business Phone Architect/Engineer - ( ) Address City State Zip Phone Contact ( ) Business Phone ( ) Lender Address City 1 State Zip Phone ( ) Describe Work ,. y; Res. Comm. At rAe.Nrr) �rt+�At. (- c X/16) 'Subdivision/PlatName/Short Plat Number------ k . Kwo lack)S !! Assessor Parcel Number Lot Block Plat Number 114 Pertinent File Numbers Zone A Comp.Plan Census Tract Asua Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage 1 Front Setback Left Setback Right Setback Rear setback R/W Width Additional Information Square Footage Z 0 4 2 cc 0 u_ z 0z 0 J_ 5 co Number of Bedrooms Building Technician Date Group Type —7— /0 -FCS _ a-t— f vJ DEPARTMENTAL REVIEW Cond. &10 Approved Hold Approval Environmental Health Application# y fr t4 CCCJJJ W.1101 College , p Room 200 111 Planning/Zoning O N.721 Jefferson Engineers ❑ N.811 Jefferson Utilities ❑ N.611 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__ ✓ . op ,44j— O"t 14C :N ,)OWI�Ac FLATS PAZ>,:- SC, -Z),L-ET"u rn. 10 V) ----------- LU op ,44j— O"t 14C :N ,)OWI�Ac FLATS PAZ>,:- SC, -Z),L-ET"u rn. 10