1985, 08-15 Permit App 00007035 GarageShow on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
• • I
4
Scale.
Date: a/150
Revisions:
Attachments:
-+-
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DEPARTMENTAL REVIEW
v
Approved
Cond.
Approval
Hold
s/
Environmental Health Permit Number
W. 1101 College
Room 200
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Planning/Zoning
N. 721 Jefferson �'�' �
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75-P71b cre r/1 -4 n.-79 / J-e pe�Wy
Engineers Permit Number
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
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 is true, correct, legal, and binding.
Owner's Signature
Date )C (25— f-e-c-
(THIS IS NOT A 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)
Or1HUCU HI'SCHO HNC run umr'Hn 1 IVI mil I hit- uoC
Project Number 76'
Owner's Name LAST FIRST MI
aie
Project Ad ress (Street NAme & Number) Zip
L // 5 6-)cS C 774/, SCE 4D0''/t1e C(,/ ,/t/y i o,t/ 7720/
Applicant
G�yq vv..i6
Address
City
State
Zip
Phone /3‘
Business Phone
( )
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
I Zip
I
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
Describe Work
f!?( — ' - *) rk) t&
Res. /
i/
Comm.
Subdivision/Plat Name/Short Plat Number
f r C 0-- Ai _26 fliAb i t t< 1 140 W14 ' a 1,
Assessor Parcel Number
6etS44—"Z2C
Lot
2)
Block
3
Plat Number
Pertinent File Numbers
Zone
12 Net ik
Comp. Plan
Census Tract
Number of Dwelling Units
1
Number of Buildings
-Z
Lot Size (Sq. Ft. /Acre)
Depth
--7
Frontage
i(J
Front Setbac/
Left Setback
Right Setbac
Rear Setback
Additional Information
fDEPARTMENT USE
Square Footage
Nam( 7 rvtCASC.,.2c L rvTS ---?
Group
Type
Building Technician
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Date
4/es<% 8s
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