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1984, 04-05 Permit App: 84A-3024 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) Owner's Name (last) (first) (m) Department Use Only e 171141 � tvh Ras.. Comm 2 Project Address (not Mailing Address) or Road Name Space Zip 3 3&0 3 0 .)444 H Q9ao10' 3 City/Community -S' IO D K F1 14t. State W a Subdivision/ Plat Name _ it1il t ;_' _(: ,--).-4,11-: 4 Assessor Parcel No. ✓ 4 _ D _-. , Lot ' Block -Z_ * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. 4 Zone Project No. 6 Dwell No. of Buildings 1-30 Sq. Ft./Acre Depth Frontage 7 Set Back -Front (L S-1 (R)S 2 Rear Census Tract Module No. Initials 16 Architect Firm Name 1\1 o rd C. 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) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) 1SEPA Exempt (Y/N) Date 15 Type Work 14 Bldg ❑ Fire ❑ MH E Demo Ed New ❑ Add/Alter ❑ Replace E Move ❑ Other 14 Describe Work IC' '-C 2 G,,,,,,d, c,N 1QglOs., C,at74 1- Isco 1 10 Applicant Name E \v1 ' 1. us K (4 Street Address ,S 'A Q 3 C3 o ,....) 6 s. 4 11 Zip 9gao4 City Snpkr,rfg State 1.,,.Jr1 Phone ( ) Sulo S3'1'1' Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information C. 1- C>; To r.--wc.v, 3,crIA * k Application Type (Standard unless otherwise indicated) Fast Track Early Start 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; ❑ �1ew Construction; Additional structure; ❑ Residential ❑ Bldg alteration/addition Releasese Release w/cond 1 Hold 2 APPLICATION # ©sb eg 6. (-2- (f ->es• Conditions/Comments: Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; 0 Other Conditions/Comments• Engineers: ❑ Commercial; ❑ ylesidential; 0 Flood Plain; N. 811 Jefferson 0 drainage V new access/approach; ❑ fence; 0 road improvements Conditions/Comments• luJf° y�' Utilities: N. 811 Jefferson Conditions/Comments• Other: El i 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 (i4 i '�� I _ r 40 I ti r5� 3 2 y 0