1984, 04-12 Permit App: 82A-3294, Garage, CarportBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (lest) (first). (m) Department Use Only
qA AA
�'}d -, elmsrIK�(°0 G mss. Comm
I
2 Project Mdreessss (notailing Address) or Road Name Space Zip
707� gerpt Arse".99017
3 City/Community
Vender( dCa_
State
/.1
Subdivision/Plat Name
I/CRA•
4 Assessor Parcel No. . (`
34 SY - 67.M • ,J
Lot Block sive
pcj / (-r 0® forr siy
* * * DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. N
Zo
Protect No.
6 Dwell if
No of Buildings
Sp, Ft./Acre
Depth
L00
Frontage
/025
7 Set Back -Front
(L)5-1
(R)S•2
Reef
Census Tract
Module No.
Initials
16 Architect Firm Name I Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
1 I✓
Contractor Firm Name •-
t1kt:lit r/%NO t—
3"
Street Address
b
Zip GtyStat
9wi ®r�r u�4,a
•
Phone
( 424 -57tY
Contact Person License No..
C
sz•is tow C inOfv EflL C t e% i4 a
Phone If different than above
( )
8 Owner/Agent (if different than N1 above)
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work 'fQ Bldg
0 Fire
0 MH
0 Demo
yea New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
New att4.1. 11 Ci3g,prntJ-
10 Applicant Name
EnEZI••. Caiff AC;rnas
Street Address
11 Zip City
490)7 aTi1 Q4 s
State
Phone
9fid-5v
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Heafth
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
C Additional structure;
E Residential
Ci Bldg alteration /addition
APPLICATION #
Rale -i
Release
wlcond 1
Hold 2
Fl.a=
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot wld; 0 lot size; 0 use/zone;
• CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments:
Engineers: 0 Commercial; ❑ Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/Comments-
Utilities:
onditions/Comments•
Utilities:
N. 811 Jefferson
Conditions /Comments:
Other:
Plan Exam
Fire Prev.
Conditions/Comments:
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
*.I p i01-7
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