1984, 10-25 Permit App: 00003007 Relocate Garage*
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) (m) Department�se Only
1(first)
ij►a�nth Vf'Y� Y\`,.`� (-, . F. 1// Comm
I
2 Project Address (not Mailing Address) ar Rgad Name Space Zip
3 City/Community
na no
State
\nI
ubdivi /Plat Name
uvr ONe 4c%/
4 Assessor Parcel No.fj
3 .43. e) /- j
Lot
1
Block
L
* * * DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act. 4
Zone
s i
Project No.
C70—?
6 Dwelt./
No. of Buildings
Sq. Ft./Acre
/`/12/,
Depth
Frontage
. 7 Set Back -From
I (L)S-1
(R)S2-2
Rear
!
Census Tract
Module No.
s
Initial/7
ietzi
16 Architect Firm Name
Street Address /�
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City'State
Phone
( )
Contact Person
License No.
Phone If different than above
( )
8 Owner/Agent (if different than 41 above)
56 �l-a
Business Address
9 Zip
City
State
Phone g
12 Review Required
Plan Check (Y/N)
Other (YIN)
SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
E MH
❑ Demo
E New
E Add/Alter
❑ Replace'
pelc1ove
cher
14 Describe Work
l"'e/C)t'l l'c/ de /ft &heti inra 9 65
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional information '1 tC 110( -T7 1ILL1KIC)1
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑ Commercial;
❑ New Construction;
❑ Additional structure;(
APPLICATION # l U
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
Conditions/Comments•
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; 9 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
O Other
Conditions/Comments.
Engineers: 0 Commercial; 0 Residential; ❑ Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/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
CtOra
S'ZL8TI
2S'
Q.--OunklA V-Ocivok
*5-L. 3tr6-0
-
STo3c7
1041•FI3Si
N,5115 ao‘kvas-
5pkan
i-04- etot.k. Lf Cwrj
61‘c Actitrk-i;n
SP(42-a *NC Cousy413
35(,;(13iq04
1
• -1
:31 -1