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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 r\f A SRP SITE MA 9 $ CSR GARAGE P Art s -DAv is 3/9