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1986, 03-31 Permit App 00010906 Remodel Garage
�S (THIS IS NOT 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 DEPARTMENTAL. USE Project Number rOwner's Name LAST FIRST MI 11 ► E. i l beer-q w; ll '(Aril CA. M ch e Project Address (Street Name & Number) `) Zip Di� 1 LI. JerS1.1-f ©Ci4ddrespoki e 99 0 P � 10 ,y 1 h r t3 IN S Applicant f)ov1 Fr 'Les/0 \i- S' C 6-ago City 6-2ee 0/gct2c-S State WcsG,, froh Zip 9?o& Phone ( ) 7.24f—/94 7 Business Phone ( 1 Contractor/Agent Address City State Zip Phone ( 1 Contact License Number (Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone ( DescribeWork •- - r c? 12 ?C Z f r t r 6 i`U Or•U -yM`EjIOre ea-IPL.E- nv -- &kki Res. Comrryl Subdivision/Plat Name/Short Plat Number r3ev1KIS -• . Assessor Parcel Number • - I"751 - OCl/0 Lot - Block /0 Plat Number Pertinent --:'7 Cs _ P & - r 7� f on l ll� 3. Comp. Plan Census Tract Number of Dwelling Units [ Number of Buildings Lot Size (Sq. Ft./Acre) I/COO Depth Frontage Front Setback EyiS7d+vG Left Setback EX.iS1`1kXJ- Right Setback -.k1ST1k1Q Rear Setback iE)4ISTtMCL R/W Width Additional Information 3-009 v4LuArly .5`(-e6 L BUILDING INFORMATION Square Footage - •-57410 < c ��t ' //, Number of Bedrooms 5- " �' Group Tye Building Technician Date Show on Site Plan: Additional Information: Lot Dimensions Landscaping Existing Structures Drainage Plan Proposed improvements Hydrants Stricture Sethacks Topography Easements Lighting Septic System (s) Signage Water Lines Shorelines Sewer Lines Highwater Mark Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Legal Description • i 7 7 tI I � 4_ • yr i } I3,c 7-- I 7 T ,i - y---1-.4 -- ---- I l ,i I T —I {-I--' I I 11 4 .r r 1 I rt DEPARTMENTAL REVIEW Approved Cond. Approval Hold Environmental Health Application # j/1_ / — " itil.‘...; W. 1101 College Room 200 fs %1/ I. . Planning/Zoning N. 721 Jefferson ` / '''% '' c , , mac Xi? P a wee y , 4 o� ,w/iij diy iw /vl e 4frA/5C,)Oi7 a Cie141, lne-e Engineers / N. 811 Jefferson .5.4ky /1/ 1_5eN ` �e.�. i i►1 lkCtVi PFi g(te V i c11n. Utilities N. 811 Jefferson �ZZ , .- eozio 's'y .5.eit �A. 4/ 4 7 Y 7 z, , „° a F'vvaii.P44i77,l V /Nlan oPrev,nZi� P `_ N. 8111 Jefferson ! D� � *o,� AfrOL 1T54-367 KeoSe Fgr Other (SEPA/Critical Materlal/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. Signature Date 3 131