1985, 07-23 Permit App 00006538 Sunroom(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)
JrIAUtU Hr'StAJ AMC rum UCr/r1 I IVICIV I AL UJC
Project Number 3.8
Owner's Name LAST FIRST MI
• 1` fC� i~ A
Project Address (Street Name & Number) Zip
/5°"=. — GP..r'j=i-R9f 1 t ?4:?'O -7
Applicant �^
' --' -7 /Y - \ ! - G /-(,, it T.
Address
City
% MPS, rJ.ct �7--...
State
Zip
9Q.�
_t
Phone
(5 7 % ) 2, Y % /(J j
Business Phone
( )
Contractor/Agent
0w.,p..f \
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State I
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
Describe Work
-DtrrvRa»-i
(12O1el
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
1«-rts6RL. N1 si 400
Assessor Parcel Number
2551/3 — 05 / 8
Lot
IS
Block
1
Plat Number
Pertinent File Numbers
Zone
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 Setback
Additional Information
LDEPARTMENT USE
Square Footage
Group
if -
Type
Building Technician
C� trx,d
Date
7-2S-
DEPARTMENTAL REVIEW
Approved
Cond.
prov
Approval
Hold
/
Environmental Health Pe m' Number
/
W. 1101 College C�qi.ag;c,,,._,-,.._,
Room 200
pumtipil-----,
Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers
811 Jefferson
N.
Utilities
N. 811 Jefferson
I
/Plan Review/ Fire Prevention �,�!y,
N. 811 Jefferson /7T Yvv�� �'/�- S I T E-
73/85
Other (SEPA/ Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
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 Signatu
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