1985, 04-26 Permit App: 00005125 Relocate ShopBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
As
(Please return this original and your building plans to the Department of Building and Safety)
1 Owners Name (first) Only
+�
� / /(llast)
,,//(m�) �LUpartmentll;ta
-5'C.4,e enA / R/iUC mss. ✓ Comm
2 Project Address (not Mailing Address) or R d Name Space Zip
Lt; /3007 ea/a/ o
3 City/Community
A /
State`',
Su !vision/Plat Name
4 Assessor Parcel No.
5'/� � `,J 1/ /
i •--/75r--e
yjl —Zone
Lot
/ 9— f
Block
_ %)
L
* * * DEPARTMENT USE ONLY * * *
5 Sic Code Act. t/
Zone
Project No.
5/25
6 Dwell 0
No. of Buildings
Sq. Ft./Acre I Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2 r Rear
Census Tract
Module No.
Initials._/\41.'
16 Architect Firm Name (Street Address
Zip
City
Slate
Phone
1 1
Contact Person
Phone if different than above
Contractor Firm Name
Street Address
Zip
Clty
State
Phone
l 1
Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than p1 above)
Busi ass Address
9 Zip
Cit
State
Phone
12 Review Required
Plan Check (Y/N)
Other (Y/N) I SEPA Exempt (Y/N)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
M
'-1 Move
0 Other
14 Describe Work
No Vet_ 10/14417 y o{l/
JoT/ ? ar7 o to %�
l
10 Applicant Name
Crf/ iii. ti,' e .ScA //,o
Street Address
C, 13007 ea /4
11 Zip
99, /C
City et
--1-pe 06 e
State
iv®.
Phone
(WY 3a//
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
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
flig5-1
Conditions / Comments •
0
Planning/Zoning: 0 Commercial; ❑ 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;
❑ Other
Conditions/Comments'
Engineers: 0 Commercial;
N. 811 Jefferson 0 drainage
O road improvements
Conditions/Comments.
❑ Residential; 0 Flood Plain;
❑ new access/approach; 0 fence;
Utilities:
N. 811 Jefferson
Conditions/ Comments•
0
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
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conc. patio
40. 2 '
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1 Story 1hake
E. 13007 Cata:do
2 6'
conc.
drive
3. 6
8 4. 5
/ 6 9.0
lots 21 - 22
/ 4- -
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CATALDO AVENUE 1
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