1985, 04-18 Permit App: 00005007 StorageBUILDING 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) v
1
2
Owner's a
Pr Jact dress (not Mailing A
(last)
ress Roa e
) (m) Department Use Only
- Ras. Comm
^ Space Zip
3
4
City/Co unit •
Assesso rcel No.
��
Stto ubdivision/Plat Name h • '
(�C/ P,�IV (.J V k C�
Lot Block
DEPARTMENT USE ONLY * * +
5
Sic Code
Zone Act. #
Zone )
1
Project No. ��
6
Dwell # 1
No. of Buildings
Sq. Ft.lAcre
Depth
Frontage
7
Set Back -Front
0
(L)S-1
(R)S-2
O
Rear Census Tract
�d
Module No.
I Is
16
Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Co actor Firm Name
_
Street Address
visa'
Zip /
9 y.2 -O b
City
U
State
toC.1-
Phone
Contact Person
icense No.
Phone if different than above
8
Owner ent (if different than #1 above)
Business Address
g
Zip
City
State
Phone
12
'Review Required
Plan Check (Y N)
Other (Y/N) SEPA Exempt (Y/ N)
-7
Date
15
Type Work
Bldg
❑ Fire
❑ MH
❑ Demo
New
ElAdd/Alter
❑ Replace
❑ Move
❑ Other
14
DescribeWorrkk
U /l &
4/ /
10
Applicant Name
SlAddress
11
Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
Additional Information
'
fv
DEPARTMENT APPROVALS
indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
I nis is not a vermit
Application Type
'(Standard unless
otherwise indicated)
Fast Track
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑
Early Start
Release
Release w/cond 1 Hold 2
❑
Environmental Health
❑ Commercial; ❑ Residential /
W. 1101 College
Room 200
❑ New Construction; ❑ Bldg alteration /addition
❑ Additional structure;
APPLICATION #
Conditions/ Comments:
❑
Planning/Zoning:
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson
❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/ Comments:
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:
O
E
a
2
C
3.
indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
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