HomeMy WebLinkAbout1984, 04-26 Permit App: 00000055 Garageii
BUILDING PERMIT A:'PLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
6
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Depart Use Only
Ips. Comm
F I
Elf ( ,L..1? -71,-1 ) v_....,. .
)
2 Project Address (not Mailing Address) or Road Name Space Zip
J. > 2 F\42 -R- IZ�i4C) 99 zoo
IJ
3 City/Community
oto--- r)E
State
\N,6-.
Subdivision/
p
Plat Name
:.c)c.2_77._ yI _) tic( (7T-- � iG4) ,
4 Assessor Parcel No.
(7 s4*j _ _ o
Lot
Block
* * * DEPARTMENT USE ONLY
5 Sic Code
Zone Act. #
Zone
Project No.
6 Dwell6
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
I Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name •
-FcSvJ IJo L.\ `I -T U • l' -k -De') 10
Street Address
-a e' =- L; . k`> .. C -t-, (7-3F
Zipp
/ 2 CD Cp
City (
-=f,)O4/- Y -....Z
State
\ja_) 4.
Phone 1
( ) ��'J c-' U 1 L!:
Contact Person
?Otte, }' 1-r. j--
License No.
—Il)-UIiN-» GS-P-1?35c)
Phone if different than above
( ) II
8 Owner/Agent (if different than 61 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N),�
,r� 5
SEPA Exempt (Y/N)
Date
15 Type Work gelIdg
❑ Fire
•
E MH
❑ Demo
114. -"-New
E Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
LIE ---w) 1,')E Ti_\. c f-G'.>�A.RneiE (20'x ./' -F- :?.,Dr 1D, )
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 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
Conditions/Comments.
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATl J #
//b
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
,
/Ae
ff
ilk
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
O Other
Conditions/Comments•
Engineers:
N. 811 Jefferson ❑ Commercial; 0 Residential; 0 Flood Plain; I
O drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/Comments*
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
2001
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