1984, 10-26 Permit App: 00003035 Garagee
' BUILDING 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 (last)(first) (m) Only
`
(Department
1-a kms -!?7f..) .- - - �ONAu� W— Rte. I Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
I10 AL: (3C/}KI - • r isYam�
3 City/Communityi-
57, 0 reitti i
State
14-:14—
Subdivision/Plat Name
VGIG "
4 Assessor Parcel No.'
1SS4- -I4oS
Lot
Block
i-01
1
r ♦ r DEPARTMENT USE ONLY * * *
- 5 Sic Code
Zone Act. s
Zone -
pi(z 2t -,
Protect No.
?X7
8 Dwell N
I
No. 01 Buildings
-�
Sq. Ft /Acre
- ..
Depth
r
Fr
t
7 Set Beth -Front - 1 (L)S-1
(R)S-2 I Rear
Census Tract
Module No
Inillals
��
16 Architect Fir Name Street Address A`7,J
Zip
City
State
Phone
( )
Contact Person -
Phone If different than above
( 1
Contractor Firm Name r
Street Address
Zip
City
State
Phone
1 1
Contact Person - ,
License No
Phone If different than above
( 1
8 Owner/Agent (if different than #1 above)
SftMj *3' ,Vt
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required,
..
Plan Check /N)
6�
Other (Y/N)
v�
SEPA Exempt (V/N)
Date
-
15 Type Work • tq' Bldg
-[L 0 Fire
0 MH
0 Demo
0 New
Q Add/Alter
0 Replace
0 Move
0 Other
14 Descriqe Work
4#74010-6 6rii°AfL..C'--cD2.2 . .
10 Applicant Name
• SRY tt, *5 *-6o l/t
Street Address
11 Zip
City
State
Phone
(5ck) ei z- o-7caS
Lenderr4)//
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Additional Information '
171
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
i
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College ,
Room 200
❑ Commercial;
❑ New Construction;
R Additional structure;
Residential
Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
j0 /•
APPLICATION #
Conditions /Comments
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions / Comments•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/Comments-
9
Utilities:
N. 811 Jefferson
Conditions/Comments'
9
Other:
Plan Exam
Fire Prev.
Conditions /Comments -
To 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
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