HomeMy WebLinkAbout1985, 04-22 Permit App: 0005046 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
P / l /�Q J
/ Z ai �C i° 1 /N. e /,/C,2U %�T
fps. _
Comm
4111111111
2 Project Address (not M5iling Address) ar Road Name , Space Zip
/D I % 5- ,�, —/F- jr-4 P / 1'' `-e-- t) k'`'
3 City/Community
5P(01/9 -iv -C._
State
0)4
Subdivision/Plat Name
4 Assessor Parcel No. a ^�
(�/ S Li :3 `-- - 3O 1 0
Lot
I `i °"
Block
-3 * * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone Project No.
6 Dwell #
1
No. of Buildings
2
-Sq. Ft./Acre
Depth I
(5b
Frontage
1570
7 Front
� ��� n t (
1 (L)S-1 I
(R)S-2
� Rear� I
Census Tract
Module No.
InitialsSet rY) .
16 Architect Firm Name
I Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City (State
Phone
( )
- Contact Person
License No:
Phoneif different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( ) 6126 -l82a-
12 Review Required
Plan Check (Y/N)
Other (Y/N) I SEPA Exempt (Y/N)
Date -
15 Type Work it)._Bldg
0 Fire
❑ MH
0 Demo
K New
0 Add/ Alter
IDReplace
0 Move
❑ Other
14 Describe Work w _' �i
yr
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
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
W. 1101 College
Room 200
Conditions/ Com men is •
❑ Commercial;
❑ New Construction;
O Additional structure;
O Residential
O Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
ss
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;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments•
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions/Comments:
❑ Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Information
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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