1985, 08-14 Permit App: 00006912 Garagemot
t
BUILDING PERMIT -APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
82
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Department Use Only
- - :'- f� // Comm
I
2 ProSt Address (not Mailing Address) cr Road ame Space Zip
3 City/Community
State
Subdlvlsi• /Plat Name I�
4
0 l
r Parcel No
`�
v/z- _ I -I
0
I —_ -
Lot
/
Block
* * * DEPARTME USE ONLY ,< ,r*
5 Sic Cade
Zane Act. ft -
Zone 11 'V
Project No (« I/) _
1/
6 DwelI 0
No of Buildings
//
Sq. Ft./Acre
-
Depth
750
Frontage
R o
7 Set Back -Front (L S-1 !
-//dl.4� -
(R)S-2 Rear
40l4/
nsus Tract Module No.
Census
Initials
16 Architect Firm Name I Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
4Conttr'acctt`o'r�'Firm Name
�,Q.
Street Address
.
Zip
City -- U
State
Phone
ntact Person
License No
Phone if different than above
8 r/Agent Of different than 01 above)
Business Address
9 Zip
City
State
Phone
1 1
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work K. Bldg
0 Fire
0 MH
0 Demo
. New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work n 0 '
a 6 X of 6 r-_ _ 2 %Za_ •..d /.-c . . . A. .
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone it different than above
( )
Additional Information
R
f
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.)
Environmental Health 0 Commercial;
W. 1101 College 0 New Construction;
Room 200 X Additional structure;
APPLICATION # S-og o -
Conditions/Comments*
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lotw/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Com men is •
•
Engineers:
N.811 Jefferson
❑ Commercial; 0 Residential;
❑ drainage ❑ new access/approach;
❑ road improvements
Conditions I Com ments•
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions/Comments'
Other:
Plan Exam
Fire Prev.
Conditions/Comments •
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
retiLCIOAACIed
E. /1.2./43
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