1986, 04-09 Permit App: 00010384 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
[ Project Number
Owner's Name /��
LAST FIRST MI
Project Address(Street Name&Number) vZip
EA-s7- Go o 9 32&Jo AVS
ApplicantJ'11 Address
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City State Zip Phone
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Business Phone
( )
Contractor/Agent _ Address
C
City State Zip Phone
( )
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address
City State Zip Phone
( 1
Contact Business Phone
Lender
Address
City State Zip Phone
( 1
Describe Work
Rte• / Comm.
Ai lc/E i) O APA-a 6 eil 44 )
Subdivision/Plat Name/Short Plat
Number
Assessor Parcel Number Lot Block Plat Number
:74/17 _ is ig
25
Pertinent File Numbers Zik `/ Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
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1
L)
Front Setback Left Setback
Right Setback Rear Setback R/W Width
Additional Information
Square Footage
z
O
F-
Q
0
Z_
C7
z
a
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5
CO Number of Bedrooms
Building Technician Date Group Type
DEPARTMENTAL REVIEW
Approvsd pp
Apprrovov al Hold
Environmental Health Application#
W.1101 College \L
Room 200 /
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson •
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention [( N/E�
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 d Date ryr-
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