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HomeMy WebLinkAbout1985, 01-30 Permit App: 00004072 Addition, RemodelBUILDING 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 (last) (first) (m) Nades Department Use Only Rko a r- y/ 1%9. Comm 2 Project Addresa4not Malli Address) crad 1Am° Space Zip J////, e , 3 City/CommunityS Subdivision bdision iv/{PI�tame Name 4 Assessor Parcel No.. 2 3 S2f 4 — 4002/ i 2- Block I ♦ a ♦ DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. ft Zone Project No. 6 Dwell M i No. of Buildings I Sq. Ft./Acre Depth 131' Frontage 90' e6�I0-ir\v 7 Set Back -Front 1 (L 5-1 (R)S-2I Rear _ it Census Tract Module No. Initials ' 16 Architect Firm Name I Street Address Zip City State Phone 1 1 Contact Person Phone If different than above ) MContractor Firm Na /J //� �i / /r C) %�f/7C IC reel GY /real -e`A l 0I e4y Street Atltlr 7 //' / �-7 X71 6 lc�/l�/./% / • / State /. oak j % /d'K Phone / ��nLice7wo Phone if different than above 8 Owner/Agent (if different 1 an el 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 ja . Bldg 0 Fire 0 MH 0 Demo 0 New 0 Add/Alter 0 Replace 0 Move 0 Other 14 Describe Work jy 1 r / cif X / aa/6 /!( 0G/ ,_ 6Q-�Cz„cetal4ra [70� 10 Applicant Name Street Address 11 Zip City State Phone I ) Lender Street Address Zip City State Phone ( 1 Contact Person Phone if different than above 1 ) Additional Information - t_ . DEPARTMENT APPROVALS • • Application Type (Standard unless otherwise Indicated) Fast Track Early Start 1 nls Is nota rermlt (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) Release Release w/cond 1 Hold 2 Environmental Health 0 Commercial; 0 Residential W. 1101 College 0 New Construction; 0 Bldg alteration/addition Room 200 0 Additional cture / WO / ' ��•; 15 APPLICATION # © tel/ 66 ylr Conditions/Comments' �• Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; o Other Conditions / Comments • • Engineers: 0 Commercial; - 0 Residential; 0 Flood Plain; N. 811 Jefferson 0 drainage 0 0 fence; new access/approach; • ❑ roadlmprovements Conditions /Comments • Utilities: N. 811 Jefferson Conditions/Comments' • Other: O Plan Exam Fire Prev. Conditions/Comments- IInformation ❑I 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