1985, 07-18 Permit App 00006474 GarageDEPARTMENTAL REVIEW
Approved
CpApproval
Hold
Environmental Health Permit Number Ail"7C) /
(,
�n
/ 'Zip
W. 1101 College
Room 200
iii
Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson
Utilities
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 agent is true, correct, legal, and binding.
Owner's Signature Date
(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)
SHAUtU AHtAS Alit t-UH UtI-'AK I M t N I AL Ubt
- ;. , t. r 1lrproject-?lumber
iL) 1" 7
Owner's Name LAST FIRST d.U-a.----
PC I Tr_ r) GUe RE Iv 1---
Project Address (Street Name & Number) Zip
Applicant -
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Address
1.
City ' '
State
Zip
Phone
( ) ';.z-. ,_. Lj
Business Phone
( )
Contractor/Agent
/x�75 I �Z Fi L v i t-b(-S
Address /`
E )/7 1% L 4&J
City,
T' UL't /U15
State 4
0
l A
Zip
c�
/ `17c-57 _
Phone
( ) G/ -o (S
Contact
License Number (Required)
Le—)TrD in 5 r� l.S2- ry
Business Phone
( )
Architect/ Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State I
Zip
Phone
Describe Work I y
11
Res.. -
Comm,
Subdivision/Plat Name/Short Plat Number
,4 Ppl \M-//E Y cS 2 /+ire
Assessor Parcel Number
lj55Z-19060
Lot
Co
Block
9
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
l
Number of Buildings
2
Lot Size (Sq. Ft./Acre)
Depth
—
Frontage ; t
30 —
Front Setback
.S
�
Left Setback
Right Setback .
� ,.
Rear Setback
—
Additional Information
I DEPARTMENT USE
Square Footage
Group
Type
Building Technician
Date
Show 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
Legal Description
-+
1
•