1984, 05-11 Permit App: 00000158 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) d0nly
�pepartmentL
✓✓/ Comm
L 11OA pc Y�)CL-1441-Ate T2_ Fie.
C
2 Project Address (not Mailing Address) cr Road Name .. \ Space Zip
lt(oO l Ed . F2E ( cIL AU • QA%OG
3 Clty/Community
1C -ANG
State
Subdivision/Plat Name
M1 RFiliScAu i2Ick Nc- AOC
4 Assessor Parcel No.
ZDZ 54\—O rart
Lot
23
Block
I
e
♦ • r DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Att.('
Zone
/�a.✓l�
V
Project No
) ��
Il
8 Dwell a
No. of Buildings
I
Sq. Ft./Acre
Depth
(46
Frontage
-a SI
7 Set Back -Front (L)S-1
3S' ac .c
(R)S-2 Rear
5
Census Tract
Module No.
5
Initials
921—
' 16 Architect Firm Name Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Contractor Firm Name
Street Address
Zip
City
State
Phone
Contact Person
License No.
Phone If different than above
8 Owner/Agent (if different than 41 above)
Business Address
9 Zip
City
Stale
Phone
( )
12 Review Required
Plan Check (Y/ N)
/.\I6s
Other (YIN)
VCS
SEPA Exempt (VIN)
-�
Date
15 Type Work st Bldg
0 Fire
0 MH
0 Demo
0 yew
Add/Alter
0 Replace
0 Move
0 Other
10 Describe Work
AtACRco C,A2ACLc
10 Applicant Name
SA hike
Street Address
S — lkcoO\ 6 . 'taE F2tCt
11 Zip
A617..aC
City
'..SCliSWG
Slate
Phone
(ECA ) G28—fo(o87
Lender
Street Address
Zip
City
State
Phone
1 )
Contact Person
Phone if different than above
Additional Information 7Mlif
o
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
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
❑ Additional structure;
sidential
Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
,, “t%
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: ❑ Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road improvements
Conditions / Com men is•
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
1
`75
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