HomeMy WebLinkAbout1984, 08-24 Permit App: 0001920 Roof CoverBUILDING 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)
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1
Owner's Name (last)
(first)
(m)
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Department Use Only
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2
Project Address (not Mailing Address) or Road Name
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1 Space
Ae,
Zip
5 oLle
3
4
City/Community
Assessor Parcel No.
State
Lot
Subdivision/ Plat Name
Block
DEPARTMENT USE ONLY
5
Sic Code
Zone Act. #
Zone/�
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Project No.
6
Dwell#
No. of Buildings
Sq: Ft./ Acre
Depth A Frontage
7
Set Back Front
�- (L)S-1.
(R)S-2
Rear
C;insusTract
Module No. Initi
Is
16
Architect Firm Name
Street Address
Zip
City
state
Phone
Contact Person
IV
Phone if different than above
( )
Contractor Firm Name
V
Street Address
Zip
Gty
State
Phone
Contact Person
License No.
Phone If different than above
8
Owner/Agent (if different than #1 above)
Business Address
9
Zip
City
State
Phone
( )
12
Review Required
Plan Check (YIN)
Other (YIN) SEPA
Exempt (Y/N)
Date
15
Type Work
Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14
Describe Work
ROO
10
Applicant Name
Pi
Street Address
11
Zip
City
q State
Phone
( ) q
Lender
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Street Address
Zip
City
State
phone
Contact Person
Phone if different than above
( )
Additional Information
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Y
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N
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V.
DEPARTMENT APPROVALS
TL! M.
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
ILS
I His Is not a rermlt
Application Type
(Standard unless
(Indicated approvals required in either "release" or "release with conditions"
otherwise indicated)
space prior to permit issuance.)
Fast Track
Early Start
Release
Release w/cond 1 Hold 2
Eff
Environmental Health
W. 1101 College
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
Room 200
❑ Additional structure; ¢
APPLICATION # _
Conditions/ Comments:
Planning/Zoning:
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; .l
N. 721 Jefferson
❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ uselzone;
❑ CLI, variance, zone change; shoreline; ❑ fence-,
❑ Other
Conditions/ Comments:
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❑
Engineers:
❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson
❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑
utilities:
N. 811 Jefferson
Conditions/ Comments:
Other:
❑
Plan Exam
Fire Prev.
Conditions /Comments:
Project Representative
Telephone
Agencies Performing Special Inspection:
C
O
1.
i0
E
2
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_
9
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
ILS
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