1986, 06-19 Permit App 00011703 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)
SHADED AREAS ARE FOR DEPAR
____
Project Number
Owner's Name LAST FIRST MI
7bDrR.//i � Zr
Project Address (Street Name 8 Number) Zip
5r /7 /7 Q/4 v, // AO gga( ),
Applicant
6.A-A4lz`
Address
City
�510oICAA:1G
State
aia,
Zip
99)-rZ
Phone
(567; 5341-ai.3 f
Business Phone l r
( )
Contractor/Agent
Address
City
State
Zip
Phone
Contact
License Number (Required)
Business Phone
Architect/Engineer
Address
City
Slate
Zip
Phone
Contact
Business Phone
1 )
Lender
Address
City
State
Zip
Phone
( )
Describe Work /
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Res. /
Comm.
vtston/Plat NamelShort Plat Number gg
11 LA-
Assessor Parcel Number
Z , 7 L74 C? ^?
Lot
G 4 (,,,
Block
4
Plat Number
Pertinent File Numbers
Zone
jr (- .
Comp. Plan
Census TracjA
um of Dwelling
:a
Units
('-
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
Square Footage
Z
0
2
cc
O
lL
z
z
0
J_
m
Number of Bedrooms
Banding Technician
Date
kb1, 9/ -
Group
r*l 'j
Type
\ /A()
DEPARTMENTAL REVIEW
Approved
CpApproval
Hold
Environmental Health Application # 7
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W. 1101 College
Room 200
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(/
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson c4//�1 �3 Q
Og
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 to compile said application is true and correct.
Signaturee�> L v sc --c
Date Q ��
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
Legal Description
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Scale:
Date:
Revisions.
Attachments: