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1984, 04-12 Permit App: 84A-3292 Storage Bldg
BUILDING 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 Namerr past) (first) (m) 17u55 Department Only Fes. Comm Space Zip 2 Protect Address (notMn�Cg Add�)a) a RRaa„�d Name — / 7702/ CArl do Fc -, 79oi1 3 City/Community GgtEtigch'�S State kit Subdivision/Plat Name . 6 co u's Aad i (g'agnc"A-5 i 4 Aaneesor Parcel No. I /R�s /e42. Lot ' fp o Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. 0 Zone Project No. ' 6 Dwell ll No. of Buildings Sq. Ft./Acre Depth - Coal Frontage (G2 7 Set Back -Front II (L S-1 70' ! 3' (R)S-2 I Rear Jg' 4?/' Canna Tract Module No. Initials '16 Architect Firm Name I Street Address kJ) pi . Zip City State Phone Contact Person Phone If different than above ( 1 Contractor Firm Name Street Address Coax fr05, -S go/ 11c?9 ii -C, .0x553 0 Zip 9 902'7 City obs otclrr��s State iii# Phone; ) 9.01/71,-/-.5-7 S Contact Person T6 11 Y1 C00 K. License No. enoKee le22g_I "la Phone if different than above ( ) 8 Owner/Agent (if different than el above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/ N) Other (Y/N) I SEPA Exempt (Y/N) Date 15 Type Work gil. Bldg 0 Fire 0 MH 0 Demo Iii New 0 Add/Alter 0 Replace ❑ Move 0 Other 14 Describe Work a -TO( -tC •-lex.Lk1...©iInc(n 10 Applicant Name �{-(� 'fit/ SS -gPi&pb -rQ /I Street Address R - iii.,p,,�t�, 11 Zip 990/.6 City �'�REOI/ACWS State WYE hone ( ) 9fl-4595 Lender Street Address Zip City State Phone l 1 Contact Person Phone If different than above ) Additional Information • 0, 0. C0 0 U A H W IL DEPARTMENT APPROVALS 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold This is nota Permit Application Type (Standard unless otherwise indicated) (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) • Fast Track Early Start v Relea• :/ Release w/cond 1 . Hold 2 � Environmental Health 0 Commercial; 19/esidential W. 1101 College ❑ yew Construction; ❑ Bldg alteration/addition Room 200 rAdditional structure; ,`"A /'" 44 APPLICATION # Conditions / Com men is• El Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot slze; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; 0 Other Conditions/Comments Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence; ❑ road improvements Conditions/Comments' El Utilities: N. 811 Jefferson Conditions/Comments- • Other: • Plan Exam Fire Prev. Conditions/Comments Project Representative Telephone Agencies Performing Special Inspection: 1 IInformati, 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold COOK BROTHERS CONTRACTING Route 2 Box 853 B OTIS ORCHARDS, WA 99027 (509) 924-1557 JOB • SHEET NO I/ /'77& C47;10/0 OF RE/Ch "! s CALCULATED BY "To /XhiOir/2/ DATE Z�i 2 99o/X CHECKED BY SCALE gin, .26 DATE legsr ),Z of- .........&L..?....'. ppecs. 43s t -1822 �q\ >77th/ eATGdo fid, FORM 204 Available from 7 ees/wa Townsend, Mass 01470