1985, 04-04 Permit App: 00004779 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 Department Use Only
.
—014Q 15 �rSS Fes. Comm
I
2 Project Address (not Mailing Address) v Road Name Space Zip
EtO"11CI C1W)%prQd1. _DR•
3 City/Community
5 Pa WA -1J e
State
t.,J 4
Subdivision/ Plat Name
4 Assessor Parcel No.
'3.s--4--3 ► 9145
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
A(,Aft
Project No.
1
6 Dwell#
No. of Buildings
Sq. Ft./Acre
Depth
r., ?
Frontage .;
2 --Z) -
7 Set Back -Front I (L)S-1
,-
(R)S-2 'Rear
Census Tract
_
Module No.
Initials
. J rt \
16 Architect Firm Name
SELF
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
S E L.. -c` .
Street Address
Zip
City
I 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
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work ,SI. Bldg
❑ Fire
❑ MH
❑ Demo
is New
❑ Add/Alter
❑ Replace
❑ Move
E Other
14 Describe Work /_ / n
s-----17 \i 1-t6' 2 <-1
10 Applicant Name
AAPA1< c- "7ANl f S
Street Address
- 1 0-7 i ct Ci MA&A ►20 -6(k.
11 Zip
19 2 o b
City
S P o
State
L14
Phone
(Sbct) 97-4 - 2 c \ b
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information f !
3'l f j( VI --I- 16' X 3 2 rt 7&04
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;
New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
-i1
Hold 2
-
011
Conditions/Comments•
El
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments•
❑
c
c
Engineers: r Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage El new access/approach; 0 fence;
O road improvements
Conditions/Comments:
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
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
cd
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A
SRP
SITE MA 9
$ CSR GARAGE P Art s
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