1986, 03-18 Permit App 00010105 Garage(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 DEPARTMEN I AI_ U
I prolecuiumber f0 fD5
Owner's Name LAST FIRST MI
ROe>�er /Vey Elie,
Project Address (Street Name 8, Number) Zip
5 13 7d- O t5/' O G I v�.k 5-;v, O. , .?2/
Cress
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Appl. '
Add1/1/4
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City
Pi e
Stat•
Zip
l eta l6
Phone
(sot ) 9.2 - 9/2 S
_.Sipoket
Business Phone
( )
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/ Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
( )
Lender
Address
City
State
Zip ----_
Phone
Describe Work
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GA KA C L (30 )C5o)
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
VG RA oAL8 //E tcrf r5 2 4 . AO2
Assessor Parcel Number
/45ii,--/026
Lot
3
Block
5
Plat Number
Pertinent Fife Numbers
Zone _.
/ assu s
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
f
Lot Size (Sq. Ft./Acre)
Depth
/5/
Frontage
/oo
Front Setback
Lett Setback
Right Setback
Rear Set ack
iu
R/W Width
cvv
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Additional lnformatjon S)E t L-Lr. r! 4
- +i*L' : 5-TORAaE- OJVL)/
BUILDING INFORMATION
Square Footage
y�
iJ' a T'
Number of Bedrooms
Building Technician
(, u)
Date
3—,8--gk,
Group
_I
Type
Show on Site Plan:
dot Dimensions
sting Structures
'Proposed Improvements
Structure Setbacks
—Easements
-Septic System (s)
kWater 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: C a a
Date: )/ / /FG'
Revisions. Attachments:
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application it
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
,
f Engineers �n��-
N. 811 Jefferson L /.per-'21 �J-e..
/
Utilities
N. 811 Jefferson
I
Plan Review/ Fire Prevention
N. 811 Jefferson
41,4:fi
�/
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