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1985, 09-16 Permit App 00007744 Duplex, 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 AHt I-01-1 utNAfi I MLN I AL Ubt I Project Number Owner's Name LAST FIRST MI CObfr OAKci(8‘-', Project Address (Street Name & Number) Zip EA4s7 EF'66 —68 Hiss/ 6 Ai 4v - gQ20& Applicant , ) ,;, 416)✓ (( - r... /IQ ' Address /'d 1 /v as-.-2.4-4 City /1 State Zip Phone Business Phone 7 0 Z Contractor/Agent Co b/fir •,•.„.•. Address / 00 c4. /.) ae- sr, aL. City 40•PU-A• State CJ.J /J s. Zip GI i z/ 7- Phone ( ) g i G- 7 Q 2 L_ Contact � �_. D � License Number (Required) PQ6L Le-x� Business Phone 1 ( ) q4c 7022.. Architect/Engineer ��✓��^ e Address City V State I Zip 1 Phone ( ) Contact Business Phone ( 1 Lender Address City State I Zip Phone Describe Work ()IL PLe/n �. Res.`-- Comm. Subdivision/Pia` 'ame/Short at Numbef Assessor Parcel Number 1rl . l 76 2- Lot Block' - 2- Plat Number Pertinent File Numbers Zone Comp. Plan Census Tract Number of Dwelling Units ri Number of Buildings 1 Lot Size (Sq. Ft./Acre) Depth /00 r . Frontage • I' Front Setback • Left Setback Right Setback ; Rear Setback Additional Information / 2/ DEPARTMENT USE Squuare Footage 6 /. / Fo-1-- ,HF (2) Cc30 = C,.113 �) r _-r k- Group R 3.. Type wnl Building Technician ( tLJ Date 0-16— S5 A-nis 7 uRzt.K v c>/2� / S DEPARTMENTAL REVIEW Approved Cond. Approval Hold l Environmental Health Permit Number 7.� //// W-85 W. 1101 College Room 200 4//�) "' °/-fl'ir-Y-Itif 6 G' Planning/Zoning N. 721 Jefferson Permit Number 9 /(o Engineers N. 811 Jefferson / /V A -,6-p / GO Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson 7-1 /•-S eV) Other (SEPA/Crltical 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 is true, correct, legal, and binding. Owner's Signature A-„( Date /t c_i4-1 Show on Site Plan: Additional Information: Lot Dimensions Existing Structures Proposed Improvements StructureSetbacks 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 Scale" Date: Revisions" Attachments: ,S,CG'/'� /, �a � �G /F9 ti