1984, 07-13 Permit App: 00001181 Storage Bldg•
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 Name (last) first) (m)
DsparimentOnly
PAnss44 A «
{Use
Comm
2 Project Address (not Mailing Ad ess)Ajd Name Space Zip
A nig
3 City/Community
3rOAwe
State
itd4
Subdivision/ Plat Name
O O T
4 Assessor
115 ° 601.
1
Lot
Block
: t , DEPARTMENT USE ONLY r
5 Sic Cade
Zone Act. Y
ZoneA 4 Sas Protect No 11,5i
6 Dwell Y
1
No. of BuildingsSq.
Ft./Acre
Depth ,
3 oo•
Frontage •
-s-
1z6
7 Set Beck -Front
(L)S-1
(R)S-z_ (Rear
l
Census Tract
Module No.
Initial
' 16 Architect Firm Name - I Street Address
JI
Zip
City
State
Phone
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street
Address
Zip
Clty
I State
Phone
Contact Person
License No.
Phone if different than above
( 1
8 Owner/Agent (if different than Y1 above)
Bus!
ess Address
9 Zip
City
State
Phone
12 Review Required
plan
Check (Y/N)
Other (YIN)I
SEPA Exempt
sexes
(YIN)
Date
16 Type WorkBltlg
0
Fire
0 MH
0 Demo
0New
0 Add/Alter
0 'place❑
Move
Other
14 Describe Work
5 TV MGR
BO t,21,,3
I0 l(
10 Ajigant Name
Street
Address
11 Zip
City
State
phon
9i 124- 2733
Lender
Street Address
Zip
City
State
Phone
Contact Person -
Phone 11 different than above
( )
Additional Information
AM .(VWLGc.Q V At Y"%t.rt/.PV) elk- tri 426,71^%4r_�
V kJ Clef; -
'_" % / q //-as-`13 ,Z.d Fa,{-/Iw.zf2.
•
4'
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.)
r, -
Environmental Health 0 Commercial; lerefsidential
W. 1101 College ❑,New Construction; 0 Bldg alteration/addition
Room 200 wr Additional stru ture;
' " APPLICATION #
i!:it 13
-
Conditions/Comments
Release
Release w/cond 1
Hold 2
taiPIN..4-4'
• ,
❑
Planning/Zoning: . . 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; . 0 lot wld; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other. . -
Conditions /Comments'
Engineers: 0 Commercial; 0 Residential;
N.811 Jefferson 0 drainage - - 0 new access/approach;
O road improvements
Conditions/Comments.
❑ Flood Plain;I
O fence;
Utilities:
N. 811 Jefferson
Conditions/Com ments•
.._ti
Other:
Plan Exam
Fire Prev.
CondltlonslConiComments•"
.,h
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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