1985, 06-19 Permit App: 00005991 Storage Sheda
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 Nam /� (last) ��/� (lust) A)
//� e / �,(i/
`
/
Cepartment Use Only
�. ✓/
Comm
2 Project Address (not Mailing Address) a - Road Name(� Space Zip
S* Z/21 fowA) 4IaeL Si'd0'ONe g a0
3 Cl Community
J0,p %eetfiJ 1L
State/ • Subdivision/Plat Name
24j4. c(1E – co2 'TC R* C6 3w---()
4 Adesetor Parcel No.
— 11 6 1 I
e2– Ser
Lot
I 7
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
jl
I Zone Act. k
`
Zone �� 5u l Project No. ��
I �(lI
6 Dwell #
I
No. of Buildings
Sq. Ft./Acre
Depth
t27
Frontage t
7 Set Back -Front 1 (L)S-1
(R)S-2
Rear
Census Tract
Module No.
Ini5Is. ,y
L G
16 Architect Firm Name I Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
( 1
Contractor Firm Name
Street Address
Zip
City
State
Phone
Contact Person
License No.
Phone If different than above
( 1
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required
/
Plan Check (V/N)
Other (Y/N)
I SEPA
Exempt (YIN)
Date
15 Type Work /e Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
Al Move
0 Other
ibe Wort'
14 Love) skeet p€ s;c�i (2$K t--.2_
10' Applicant Name
Street Address
11 Zip
City
State
Phone
t4)1 PLL — to17
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
Additional Information
DEPARTMENT APPROVALS
•
■
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
1 ms Is nota rermii
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
j--�'
j!/
W.En1101 Collegeontal Health 0 Commercial; 0 BldResg alteration/addition
Room 200 0 New Construction; - 0 Bldg alteration/addition
0 Additionalal
structure;
APPLICATION# U S—
Conditlons/Comments'
i
Planning/Zoning: D Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 tot w/d; 0 lot size; 0 use/zone.
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other -
Conditions/Comments
•
Engineers: D Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 0 fence;
new access/approach;
❑ road improvements
Conditions/Comments-
•
Utilities:
N.811 Jefferson
Conditions/Comments.
•
Other:
r/
Plan Exam
Fire Prev.
ctC-R-
-R-
Conditions/Comments'
Conditions/Comments'
i❑ uogewJoluI
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
-+s
r
This document is being sahMitted far'.°: ._Pei
of obtaining a hiiding permit
correct represon.ciea tc n :a
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