1984, 08-29 Permit App: 00002023 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 lka'Only �/�L
rnAkeZ4nSk1 e_± 1_, fa, Comm
I
2 Project Address (not Mailing Address) or Road Name Space Zip
S. 2-211 ea1u)'n (1Utadc)1 W CAO 7
3 City/Community
5101/0tRn?
State
Ik 1P1 '1(i rOlk
Subdivision/Plat Name � n
_ ' rl � au))J .c ICC+ Acid (# i o lei
4r Parcel No.
i Z10-542.-.
/ Gil/it— 2303
Lot
3
,Qlock
12- t f + DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. St
Zone Project No.
6 Dwell It
No. of Buildings
I
Sq. Ft./Acre
Depth s
\[7—
Frontage
gz1
7 Set Beck -Front
(L Sj-1 t� ..
(R)S-2 1 Rear' r.
—1/
Census Tract 'Module No.
Initialg �
Z
16 Architect Firm Name I Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City
I State
Phone
( )
Contact Person
License No.
Phone if different than above
8 Owner/Agent (If different than 01 above)
Business Address
9 Zip
City
State
Phone
1 )
12 -Review Required
Plan Check (Y/N)
VCs
Other (Y/N) a SEPA Exempt (YIN)
YES 1
Date
15 Type Work G BIdg
0 Fire
❑ MH
0 Demo
0 New
t "Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
)%i'acq-brco C,AQ c,t 24)(3D-
(3 i10
10Applicant NameStreet
S/` L. ma�Q- nk)
Address
s -ZtM cck.lu)�
11 Zip
Ggo32
City
1)ecl.do-lF
State
o .
Phone
(Sot) 9ak_1028/
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 nota Permit
(Indicated approvals required in either "release' or "release with conditions"
space prior to permit issuance.)
Environmental Health 0 Commercial; ❑� Residential
W. 1101 College 0 New Construction; ❑"Bldg alteration/addition
Room 200 0 Additional str cture;
APPLICATION ft
Conditions/ Comments•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot wld; 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 new access/approach; 0 fence;
O road Improvements
Conditions/ Comments •
Utilities:
N. 811 Jefferson
Conditions/Comments.
9
Other:
Plan Exam
Fire Prev.
Mihr
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
Release
Relea�►/sees
w/cond 1
Hold 2
Conditions/ Comments•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot wld; 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 new access/approach; 0 fence;
O road Improvements
Conditions/ Comments •
Utilities:
N. 811 Jefferson
Conditions/Comments.
9
Other:
Plan Exam
Fire Prev.
Mihr
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