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1987, 09-26 Permit App 00013316 MH for Storage(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) Project Number /3 / Owner's Name / LAST FIRST MI Cel e-J.^c!2-�I.(--)e .--✓Qy�/x-) Project Address�ss(Street Name & Number) / Zip /' !Z 7 7 Ci /a.j4 6,- "e"� 'S�% /S6Qc _— ' Applicant Address City State Zip Phone ( ) Business Phone ( ) Contractor/Agent `57C_-%^%7 e Address City State Zip Phone ( ) Contact License Number (Required) Business Phone ( ) Architect/Engineer -SQ,n e Address City State I Zip Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone ( ) Describe Work 7t> A TLD (O X5s) Res. / Comm. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number Lot Block Plat Number Pertinent File Numbers Zone �n i'lh'ic i Comp. Plan Census Tract Number of Dwelling Units Number of puildings Lot Size (Sq. Ft./Acre) Depth Frontage Front Setback Left Setback Right Setback Rear Setback R/W Width Additional Information BUILDING INFORMATION I Square Footage Number of Bedrooms Building Techhnnicciian� Date Group Type DEPARTMENTAL REVIEW Approved Cond. Approval Hold Environmental Health Application # 2.=-4W.1101 �--� CollegeRoom 200 "k-' --7---7--- Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson I Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Materlal/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. Show noSite Plan: Lot Dimensions Existing Structures Proposed improvements Structure Setbacks Easements septic system (s) Water Lines Sewer Lines Fences, Wells night Of Way Width(s) Names of Fronting Street Flanking Street Additional Information: Landscaping Drainage Plan Hydrants Topography Lighting 8ignoye Shorelines Highwo1aryNurh Le -al [)escription ' / � / | ` � ^ / | | � | / | ^ � _ � | . . . . ` r � | / | � | � | ' | L � / | | | � / . . . . . ' | [ | � � / | , - | / � � � | � �\S.. ` ! i\ | | | | � ! / . . / � � |~ ' 10 i* | � � ., . --1 - � - | | | / | | | | w | } ( - . . . . . . / | � ~_ �7-,4 \ / | | � | T | / / i | / / / } � / � --�---�-f � | | -J � . / L . | f / / ' / � / | ` � ^ / | | � | / | ^ � _ � | . . . . ` r � | / | � | � | ' | L � / | | | � / . . . . . ' | [ | � � / | , - | / � � � | � �\S.. ` ! i\ | | | | � ! / . . / � � |~ ' 10 i* | � � ., . --1 - � - | | | / | | | | w | } ( - . . . . . . / | � ~_ �7-,4 \ / | | � | T | / / i | / / / } � / � --�---�-f � | | -J � . / L . | f / /