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1986, 06-04 Permit App: 00012666 Residence, 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) �f,-, SHADED AREAS ARE FOR DEPARTMENTAL USE I `�- 7� Project Number Owner's Name L T FIRST MI � A11 ,ice krvv Project Address(Street Name&Number) Zip FAS% /Q-i t8 a kiit-jA QoN 992e6 Applicant H/ i ile L 4 // t/C r ���� Address 5 �,, /]!n/�`} (yllJ'_l! � V�(�ILWWk f� 0 Cis J�(/l p 611a Y z. StatQ - ' � J Phone ( l !�� (J/( Business Phone ( ) Contractor/Agent �� j� ` Address L- JOU 2- aeptc.:3 City State Zip Phone Contact License Number(Required) Business Phone PR]ME- El ii ( ) Arc itect/Engineer Address ©n a ( t 4l4. lhoe S1 . < City State Z i Phone /voK , 1 Q 3 S- c . Cotact Business Phone ( ) Lender Address \ i t //nq S I� �'\ S l i'teG� �l°-� 1 t (J State Y `J Zip Phone ( Describe Work Res. Comm. r =: dr`-'C/ Jo - w`c 4 /2A 2 ` '1. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number (a/ Lot Block {Plat Number ..,.::;,-- ,ff..)4in — 14.4, Pertinent File Numbers Zone Comp.Plan Census Tract APar-I Number of Dwelling Units I Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage . • ! I r /•t-7 Front Setback Left Setback Right Setback Rear Setback R/W Width Additional Information Square Footage F m Number of Bedrooms Building Technician Date a Group Type Waal &I/—PC IA)/c,L » 6/is - , 12-3 vn! DEPARTMENTAL REVIEW Cond. Approved Hold Approval / Environmental Health Application# ��f13 " \CtrA (�/u W. 1101 College $�p�- Room 200 frt_.4) Vdd Planning/Zoning (OM N.721 Jefferson e• et: ea--(1W VX-otit,-e-ec • IL Engineers , � N.811 e r-rson .0- i� ��_ .i ,. �.li_i� i _� /O./' -d ._::ffi_. .� '�/2.a_i_� /_ �' •lam'_' ✓� Ai/G�.�%Jr11�/� // �ti 05r, IIII A1_ i / , _ �._, � .CI • Utilities U.L vati ❑ N.811 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 ageht to compile said application is true and correct. /(/''a? Si9 nat e i Show on Site Plan: Additional Information: Lot Dimensions Landscaping ! { I Existing Structures Drainage Plan I + j { Proposed Improvements Hydrants 4 j 1 1 I • Structure Setbacks Topography Easements Lighting II { Septic System(s) Signage I ( { I I { Water Lines Shorelines Sewer Lines Highwater Mark F 1 f t Fences,Wells } Driveway(s) I Right of Way Width(s) { Names of ff Fronting Street Flanking Street f � ,, f { I j I i O - -- sr — i i 1 I l 1 { E I z I 1 4 (i)(i :-.,,L.-„, _ � r! - ' } ' 1{., =! — I j i • I j�c , 0,.e �t � — - ram- - ►, 1 I . -- i - _ I .�� - ( - — - 'r V*7 - j j i j ! __ arcv- i 1 ,) a-i.yt - � —(_ } — {_ I F _ A:11 ,, ,,,,Ipxmi.A.-A,0 _ i . . . — -- I _iti 6 a o vet,, rujui 1I - _1� �0 �z - ;-)Q — j j I i . -- i. j ! _ I ....(t )- —ow-- 1 IL , - Scale: � . -1 { - } H i 1 !I IDate: j I t-- Revisions: Attachments: I I -- --�-- �J ~-- ` • JUL-22-'88 16:88 ID:HEALTH SP° TEL NO:589-456-4716 #814 P81 -- I ,' 1,1,t i 1. ,,111;: I, .•+ t'1. '1 ' I•' 1"•'• ' a•. !',r—(• ,, • '1, I. i f' r.h; ', I.I. r t ti ' v �'+' ' �+ • ti +ap mniwr.r,,,,..- - .} , 'Av'7 4,�; Nui'Ti, 'i ,� ,. i'l`,14 ' I , t ,' 1 +y M i.''.i#1�ti. I'* f 1/tl f ° +�;; .ti.. . , ,t ( , s 1,' s, . ''� 1.i 4 1 r • „.„, . ,, . . , •-„ late I', . T.. ,L.: ' i'...„, ,4 C•11 71', 1/,',1'.4 1 V• ! "..', /; 1• . ;+*,• ,' �* 1, f • Mre ,,, ., It, t • i '`,II Irr'1_A.1`•'i. • 'i' ',4 !NI r,,' 11 ,, , '',1 1 '+ 'ti 1,1 f ..1 4' °yru .-'4I M.I.„ I' 111 , . t, / , a' t 1' i'1 1i k''t•I f '# f II • � .w i 1 ` ' ' •'fA t' '►''' I'� ,' '• .' t•:' g' . . 4 , • ., ' I 4.,481 4, ,r i • 1 7 ,r 44. , , ' ' , ..; da'MC ' 'A 1.4, •r ,.,�- , , i (IN • ,1 i . . Of V.'',t ' i 0 ' • 4 t t Xi kj tipp AA i •v eil : ,1' ,; , •to. . , . •,''' 1 ; /_ i,cot 5• • •. II i 2..44 , ''0 .t,1 ,y, • :.• ,, ' ' 't . {nor111/// }, ,aMwsr-�.-�....—:T.T.-• 4'' II,.u.,rri.,r Mll�,l .^r ..x,•. ... _—••••MP,.•ref,NA'............4.' 45 , 1 , e „ V .. . 1 ell. , t .. .Fly I jig