1984, 09-05 Permit App: 00002114 GarageBUILDING 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)
46.QCe s�rlaC�VGI �,.y fife
Department use Only
1422.
Comm
2 Project Address (not Mailing Address) a - Road Name Space Zip
/SOG 4/ {4t7- PCI 9F'Zos
3 City/Community
SP015Ary-R
StateSubdivision/Plat
(,v
Name /
CPp�orf crn iv
4 Assessor Parcel No. ,nE V/ — DC/o5
Lot
Black
* * * DEPARTMENT USE ONLY
5 Sic Code
Zone Act. p
Zone
Project No.
I
_AS1
6 Dwell M
/
No of Buildings
2-
Sq. Ft./Acre
Depth
350
Frontage
X80
7 Set Bads -Front
Jib
(L)S-1
5`D
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name Street Address
Zip
City
State
Phone
1 )
Contact Person
Phone If different than above
Contractor Firm Name
Street Address
Zip
City
State
Phone
Contact Person
License No.
Phone 11 different than above
)
8 Owner/ Ag t (if ferent t an 41 above)
<WG OL. -
Business Address
9 Zip
City
State
Phone
( )q27-ozc--7
12 Review Required
Plan Check (Y/N)
Other (YIN) ISEPA Exempt (YIN)
Date
15 Type Work % Bldg
' - 0 Fire
❑ MH
0 Demo
jK New
0 Add/Alter
❑ Replace
- 0 Move
❑ Other
10 Describe Work
p� ,,,e, City Q,Catt. 3o r 60 /ROC ft
10 Applicant Na a
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone 11 different than above
Additional Information
DEPARTMENT APPROVALS
•
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
/
This Is nota Permit• "
(Indicated approvals required in either 'release" or "release with conditions'
space prior to permit issuance.)
Release
Release w/cond 1
Hold 2
Er
Environmental Health ❑ Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
2,.(N..),_APPLICATION
#
Conditions /Comments'
Planning/Zoning: 0 -Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions / Comments•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments-
Utilities:
N.811 Jefferson
Conditions/Comments'
•
Other:
•
Plan Exam
Flre Prev.
Conditions1Comments-
Project Representative Telephone
Agencies Performing Special Inspection:
1
I Informati
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
3
b
V.
- ----- ---4
LE: IAL 1;1:,"1 -',Irr''��
.: • " u lir ,,. r
Yek-',-14i0FtIV
tyke'* Y
64%. fit
r --y• •
,_�s.