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
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