1985, 04-08 Permit App: 00004860 Garage AdditionBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last)
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2 Project Address (not Mailing Address) or Road Name
A/R , c/
3 City/Community
(first) _ (m) 1Departme Res. nt Only
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Space
State
Zip
IComm
Assessor Parcel NS 4
5 Sic Code
6 Dwell
IZone Act.*
Lot Block
Zone • tit
I Subdivision/Plat Name
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I♦ ♦ DEPARTMENT USE ONLY * * *
Project No
No. of Buildings
Sq. Ft./Acre
7 Set Back -Front
16 Architect Firm Name
1 (L)S-1 I(R)S -2
Rear
Census Tract
l
Depth
f �c7
Module No
Frontage
Initials
IStreet Address
Zip
City
State
Phone
Contact Person
Phone if different than above
Street Address
Contractor Firm Name
Zip
City
State
Phone
Contact Person
License No.
Phone If different than above
8 Owner/ Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check. (Y / N )
Other (Y/N) I SEPA Exempt (Y/N)
Date
15 Type Work
Bldg
F'. Fire
❑ MH
❑ Demo
w
Add / Alter
Replace
El Move
Other
14 Describe Work
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10 Applicant Name
61_ (21-x .2 )
Street Address
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11 Zip City State
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Phone
Street Address
Lender
Zip
City
State
Phone
Contact Person
Phone 0 different than above
Additional Information
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