1984, 08-14 Permit App: 00001755 GarageBUILDING 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)
N231113.
,1 Owner's Narne- -(last) (first) (m)
meet
L• . _.=is _
V
Comm
2 Project Address (not Mailing Address) cr Road Name- Space - Zip •
x/%443 E" 506A/ ... `: , y of ics• ''.
3 Clty/CommunityM - I
5Fb /1/�101�
State
&ht.)
Subdivision/Plat Name
sslcc s .a•nc ..: - < &aeuv flc-ces
4 Assessor Parcel No.
1 8 S, 7 __ (<77 i •
Lot
(L
Block _. - .. ... .. . -.... ..
/i IV _ • • _♦_ DEPARTMENT USE ONLY, ♦ • • ti
.: 5 Sic (hde
Zone Act. N
Zone Protect No.
K, 6 DweIIN" - -.
No. of Buildings
-
2'.
Sq Ft./Acre
Depth
1 430'
Fronta e
'.
r) 7 Set Batic-Front '
(1)5-1
(R)S`2 • Rear -.
�1sus Traol Module No.
In' Is
i6 Arr7lileC Firm Nmne Street Atltlrest
A,I_ _ .. .
_
_. .
Zip
I -
I
cntxt meson _ _ r. ,, ,-
Phone if dilleront then above
Lbntra for Firm Name Street
�en-5 e.
Addrms _
„N�,
.�o�� MA 4g
Zip
Tt07 ..
Qty
l o ,��
State
1 wN
Phone
(509) 51 7-X096
Contac{ Person
License No.
_
Phone If different than above -
8 Owner/Agent (11 different than N1 above)';
_ fjI
^.
•
Bust
ess Address
'
9 Zip
City_ , _
State .
Phone •
12 Review Required
Pian
Ch (Y/N)
• .11Es
Other (Y/N)
Ycc"
-
SEPA Exempt (YIN) _ __ ... -
Date
15 Type Work p
0
, Bldg --
Fire
0 MH•
0 - Demo - -
0 New
❑ Add/Alter-
Replace -
❑ Move_'- _._ _.. ..
D Other
.._ ..
14 Describe Work �� /77-016
�EGLa4er
,-
D C.,7/46CSE
- --Darr--•e Gs
& -.Ue-w - %r4lAetr- .
10 Applicant Name
-0 Jr C-4.6- -
G.—Ga��
,-,7;.t/
Street Address
NSoil u. _E 5•
11 Zip
1901e7-•
Qty
`-°s4 =.
State
-
Phone
---5-49-7 ). ys7-3094;__
Lender . - _ ...
/•�/
_ I Street Address
. Zip
,.-
Qty _ -_
State
Phone
Contact Person - -
Phone If different than above _
Additional Information _ •
,fn714 /4/SadgH- ` 4e 4iit/l1 - Dur-';5t_Ddi dbErar&2f4
`/A/ . gSt&7L'T i•tts> r• - _ .._ ._ .
_ ..
.1+k', leo ..
Application Type
(Standard unless
otherwise indicated)
Fast Track ,
Early Start
may.
DEPARTMENT APPROVALS
This is nota Permit . .
(Indicated approvals required In either 'release' or 'release with conditions'
space prior to permit issuance.)
LL/
Environmental Health 0 Commercial; " "- "" • " sidential ' —
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200. poi -Additional structure; . .. - - -
APPLICATION #
Release
t
Release
w/cond 1
Hold 2 .'
;-f-B4
1
r
Conditions/Comments.
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; , 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot wld; - - - 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other • N , - .
Condltions/Comments
Engineers: 0 Commercial;- ; - 0 Residential; 0 Flood Plain;
N.811 Jefferson , ..O drainage - . 0 new access/approach; . 0 fence;
O road improvements'
Conditions/Comments: - -
--w
.004
Utilities:
N.811 Jefferson
Conditions/Comments:
- 1
r :in,
❑
Other: .. ...
Pian E:
Fire Pr
cam • -. . ..
ev.
-
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 .- .,„. .......-,