1984, 09-21 Permit App: 00002429 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)
1 Owner's Name (last) (first) (m) Use Only
17epartrnent
/
( 1 )d S () I'7 / / l 1 / Res. Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
CC lUviceJor' i -f )/ 14 .
3 City/Community
State
Subdivision/Plat Name j
DM P -TU N ! "72.5 FT 0 F-
4 Assessor Parcel No.
2 (`3
y L I r 16103
5-4
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
Project No.
6 Dwell #
t
No. of Buildings
2
Sq. Ft./Acre
Depth i
32-5,1
Frontage )
'72s
7 Set Back -Front I (L)S-1
(R)S-2 i
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Zp%t.'lt'j= l.'� -ham .1u`-SC,�
Street Address
'4-. -Z7 5'C,� 11/1",t---7--/ t1
Zip
City
State
Phone
Contact Person
License No.
Phone If different than above
( ) 90 .TS -- 6 ($-c--/
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work ,l Bldg
0 Fire
0 MH
0 Demo
0 New
❑ Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
�,..e T:J h r.c:, 6 IC) le ti L --
iC 3 0
10 Applicant NameStreet
7r—
Z,///,e- �r ' f=- JL -lc_ t�'S-f-' .,\...._)
Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments.
C Commercial;
❑/ New Construction;
® Additional structure;
❑ Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1 Hold 2
EMI
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments:
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road improvements
Conditions/ Comments:
Utilities:
N. 811 Jefferson
Conditions/Comments:
Other:
cci
co
c
EI
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
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