1986, 09-17 Permit App 00013175 Storage Bldg(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 DEPARTMEN I AL Ubt
1 project Number
Owner's Name LAST FIRST M I
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Project Address (Street Name Number) Zip
Ic' 3 03 /%L1/s.r%
Applicant
eV's /1107iv"�, ar- CorS •
Address
,- ex 7%
State
Zip
Phone
City
M(G
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Business Phone
( ) 5140 ! i ..------
Contractor / Agentt
0/
Address
_
City
State
Zip
Phone
( )
Contact
License Number (Required)
Atik- C s «c
,e ?.2I4 /Z
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address -.
City
State
Zip
Phone
Describe Work
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Subdivision/Plat Name/Short Plat Number
O02TtANkq' RLA.4.7-'3
Assessor ParcelceNumber
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Lot
Block
Plat Number
Pertinent File Numbers
Zone
AG, S c., e.
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth (
Frontage
Front Setback
Left Setback
Right Setback '
Rear S , fc
R/W Width
Additional Information
I BUILDING INFORMATION
Square Footage
Number of Bedrooms
Group
T
Techni
7.(4
Date
9�7f-)iv
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
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DEPARTMENTAL REVIEW
Approved
Cond_
Hold
Environmental Health Application # / c 7.
J.
Approval
W. 1101 College 9
Room 200
Planning/Zoning
N. 721 Jefferson
I I
r
Engineers
N. 811 Jefferson
I
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.
Signature _ Date