1986, 04-17 Permit App: 00010535 GarageP N
(THIS IS NOTA PERMIT)
BUILDIIj$rPERMITAPPLICATION 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)
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Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
StructureSetbacks
Easements
Septip System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
Seale:
Date:
Revisions: Attachments:
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DEPARTMENTAL REVIEW
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pAPProval
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Hold
J Environmental Health Application1 '/J-�) lrl1
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7 W. 1101 College
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Planning/Zoning
N.721 Jefferson
Engineers
N.811 Jefferson
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Utilities
N_811 Jefferson
Plan Review/ Fire Preventionst I
N. 811 Jefferson
84
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Other (SEPA/CrItIcal Material/etc.)
Fast Track/Special Inspection information
Project Representative
Phone
Address
I certify that I have examined thls application and state that the Information contained In It and submitted
by me or my agent to compile aald application is true and correct. /—yI
7 C.d Q
Signature./ tnYf/ L-a�iHD/1 Date / — /