1985, 01-29 Permit App: 00004063 Patio EnclosureBUILDING 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 Namelast) (first) /� (m)
�' ��P3Y N L—E. ,
Department Use Only
Ft313.
Comm
2 Project kdclress (not Mailing Address) cr Road Name Space Zip
'a11 ck 60‘,Q iS to r-7-1, .
I 3 G�ryICO nit
`�h
State
/ SubdivlsionlPlatName
sum VAIuCy ACgES PL -
4 Assessor Parcel No.
OG r1- 2* _ iSI 3c
v
f' IF
Lot 1 Block
* it* DEPARTMENT USE ONLY * * *
5 Slc Code
Zone Act. #
Zone
Project No.
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Baric -Front
I (L)S-1
(R)S-2 IRear
Census Tract
Module No.
Initials
f
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 #1 above)
Business Address
9 Zip
City
State
Phone ) c.9%- t aLp
12 Review Required
Plan Check (YIN)
Other (Y/N) 1 SEPA Exempt (Y/N)
Date
15 Type Work jer, Bldg
0 Fire
❑ MH
0 Demo
❑ New
% Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
F{.1c i t CO Fm -to o FON SPA
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
UP(t t1 AllZ l') = to1 °' M
DEPARTMENT APPROVALS
0
fl
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
I III lb I lUt d rer MIL
(Indicated approvals required In either "release" or "release with conditions" .
to issuance.)
space prior permit
Release
Release
w/cond 1
Hold 2
Environmental Health 0 Commercial; El Residential
W. 1101 College P, New Construction; D Bldg alteration/addition
Room 200 CI Additional structure;
APPLICATION #
Conditions/Comments:
El
Planning/Zoning: 0 Commercial; D Cert. of Exemption; CI Frontage;
0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
N. 721 Jefferson
0 CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/ Comments:
El
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road improvements
Conditions/Comments:
111
Utilities:
N. 811 Jefferson
Conditions/ Comments:
111
Other:
0
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 bulit approval
2 indicate above or attach reasons for hold