1986, 09-12 Permit App 87000093 Kennel Addition(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 DEPART
... _.. _.._
Project Number
Owner's Name LAST FIRST MI
/, Cr/ /P. h„ 714
Project Address (Street Name & mber) Zip
�/7 SUS 6'0 -/-t(do 9-70/,
Applicant I Address
City
State
I Zip
Phone
Business Phone
Contractor/Agent ,y
(i/41l ey/
//'
Addr
ess _
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
Architect/Engineer
P
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
- - - Address
City
State
Zip
Phone
( )
4.
n� far /0 i io % 8 7/ix
Res.
Comm.
///
sR)tbdivlston/P!at Name/Short Plat Number
ltr�; ,cA57/ 2c A, 6 g--S. £ . Tr- 02.0. cis/1(1c%46h
Assessor Parcel Number
z _s - ? O?3
Lot,
Block
20
Plat Number
Pertinent Fife Numbers
Zone
Plan
Comp.Aac
Census Tract
Number ofbwelling Units
Number et Buildings
3
Lot Size (Sq. Ft./Acre)
5,2f0F e'
Depth
. 610
Frontage
s s
Front,Setbaek '
. { C
Lett Setback
Ri ht 4etb
9 ack
Rear Setback
R/W Width
Additional Information
r -
BUILDING INFORMATION 1
Square Footage
/3154174-16
v.,
yi i7.vF .1)`
ggir '
Number of Bedrooms
Bul)ding Tech nigl
Date
Group
Type
C
r,
'J
u
u
DEPARTMENTAL REVIEW
Approved
Cand.
Approval
Hold
Environmental Health Application ff
W. 1101 College
Room 200
14,11'ginning/Zoning y /
N. 721 Jefferson
A
H v O G/
E�Iwsers c>:rtL,lrtEs ' ?,zti�� 1
N. 811 Jefferson
L L5L7 S'eertirt Ed t �cr.+�Q��r��ar41
Hllfm a cr�c-�In�EE2_ N. 811 Jefferson
Plop Review/Fire Prevention R�>/
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. q
Signature Date—?
Show on Site Plan:
Additional Information:
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
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
•