1987, 02-13 Permit App 87000363 Garage & Barn(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE Project Number
Owner's Name
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FIRST
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Project Address sitreet Name & Number)
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Zip
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Applicant
Address
city
State
Zip
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Phone
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Business Phone
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Contractor/Agent
Address
City
State
Zip
Phone
( 1
Contact
License Number (Required)
Business Phone
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Architect/Engineer
Atldress
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city
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Zip
Phone
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Contact
Business Phone�.
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Address
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State
Zip
Phone
Describe
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Res.
Comm.
Subdivision/ Plat NamtrTSjort Plat Number
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Assessor PartedNumber
Lot
Block
Plat Number
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Pertinent File Numbers
Zone vr,
comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq.1yF`tt'.11t1Acre)
Depth
Frontage
Front Setback
Y
Lett Setback
Right Setback
Rear Setback
R/WWidth
Additional Information
Square Footage
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Number of Bedrooms
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Legal Descr�tian
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Scale:
Date:
Revisions:
Show on Site Plan:
Additional Information:
Lot Dimensions
Existing Structures
Proposed Improvements
StructureSethacks
Easements
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Septic System (s)
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Descr�tian
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Scale:
Date:
Revisions:
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DEPARTMENTAL REVIEW
Cond.
Approved Approval
Hold
Environmental Health Application M
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson -
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 1 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.
SignatuDate