1985, 09-20 Permit App: 00007589 Storage NuildingBUILDING 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)
C: i /%'i t-A/hr c7->` r✓`
p�rtrnent Use Only
Ras. Comm
Comm
2 ProjectroAddress (not Mailing Addr6ss) or Road Name Space Zip
?i 9 ,v lie, r N i
3 City/Community
S t 4-49 /c" J')
State
/�A
Subdivision/ Plat Name
W N1Tr .t�'Dfl ID 00
4 Ai..'C SS 1 ( — Q 3
((((f
Lot
Block
,t . it DEPARTMENT USE ONLY it it it
5 Sic Code
Zone Act.*
Zone
Project No.
-75F 9
6 Dwell*i
1
of Buildings
2
Sq. Ft./Acre
Depth i
'2-'4/3IOar
Frontage
7 Set' -From c
1 (L S-1 ,
(R)S-2 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 /,/
7// S ja,v Z ; 41\ ----/(crit/ ' c /ori _
Street Address
r/0/ ..z.,1 3Y „1 --___Zip
['City
�� 5/.3/o o / L A/ i,
State
, JA
Phone
(So?) y..cS — y-'34 efS'
Contact Person
_S''7,9 rs/ / 1 / Cr-I,e �:
License No.
4//St/7 C / 7 /0 f
Phone if different than above
( )
8 Owner/Agent (if different than N1 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 Q.-11ldg
❑ Fire
❑ MH
❑ Demo
C4 --Fre;
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work �/� y �/ [ ,/A
g T' X / ? S „ 0, ii /✓ Ci' \S-'74 c ,,;) 99 C
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
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•
❑ Commercial;
❑ New Construction;
❑ Additional s)Tucture;
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
11.1!41.
in
Planning/Zoning:
N. 721 Jefferson
Conditions/Comments.
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Engineers:
N.811 Jefferson
Conditions/Comments.
❑ Commercial;
❑ drainage
❑ road improvements
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions/Comments.
Project Representative Telephone
Agencies Performing Special Inspection:
1
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
1
(00