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1985, 04-02 Permit App: 00004734 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) /74 47%Y0 �, /" • / . Department Use ly its. Comm 2 Project Address (not Mailing Address) o- Road Name Space Zip E.//9/t7 2iv./e.,ra'c 3 City/Community State Subdivision/Plat Name 4 r Parcel No. Oc-16 T/ ` 6-3 ei T Lot Block 2 t r+ DEPARTMENT USE ONLY * * 5 Sic Cade Zone Act.tf Zone A�s, /J� Project No. 6 Dwell$No. / of Buildings % Sq Ft./Acre Depth Frontage >0 7 Set B& -Front (L5-1 (R)$= 1 Rear Census Tract Module No. Initials 16 Architect Firm Name Street Address Zip City State Phone ( ) Contac Person Phone If different than above Contragtor Firm Name ci le/t-4(»AtS f , C 4/ J. Street Address iu'1.-/ei /11#.Iy`R'e/h rC< Zip 9 i City jpc,�-,A State 2.614,7 Phone ( ) 9.x6 -70/`z Contact Person License No. C' /Mite A/6. zi'-/1a9/al Phone If different than above ( ) 8 Owner/Agent (if different than 111 above) Business Address 9 Zip City State Phone 12 Review Required Plan Check (Y/N) Other (Y/N) ' SEPA Exempt (YIN) Date 15 Type Work )= 1idg 0 Fire 0 MH 0 Demo 0 New ,-iii.*•"Add/Alter 0 Replace 0 Move 0 Other 14 Describe Work .25/X.zel . off. Q 4 .p _ : 5710 0:- " 10 Applicant Name Street Address 11 Zip City State Phone ( ) Lender Street Address Zip City State Phone Contact Person Phone If different than above ( ) • Additional Information DEPARTMENT APPROVALS • Application Type (Standard unless otherwise indicated) Fast Track Early Start 1 nis is nota rermit (Indicated approvals required In either "release" or "release with conditions" space prior to permit issuance.) -_ Release Release w/cond 1 Hold 2 Environmental Health 0 Commercial; 0 Residential W. 1101 College 0 New Construction; 0 Bldg alteration/addition Room 200 0 Additional structure; _ .4 •i �� I ( � � t APPLICATION # / A- / / Conditions/Comments' Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; ❑ Other onditions/Comments-0 Conditions/Comments- 0 Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain; N. 811 Jefferson ❑ drainage 0 new access/approach; 0 fence; ❑ road improvements Conditions/Comments' ' • Utilities: . , N.811 Jefferson Conditions/Comments- • Other: • Plan Exam Fire Prev. Cond ltions /Com men is• ' Information ❑ 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 4 ADDRESS: General - ❑ Owne.rship ❑ Applicant ❑ Contractor O Architect 0 Address O Legal Description PROJECT #: Health Increased Lot Coverage? Addition Bedrooms/ Fixtures? • Change of Use? New Septic? Planni O Parcel Number Unplatted Property? Lot Depth: Width > 3:1? (Less than 10 acres) Lot Depth: Width > 4:1? (10 acres plus) O Zoning Lot Size Less than Minimum? O Site Plan Segregation of Platted Property? O Plat Map Setbacks Less than Required? 0 Permit Description Frontage less than Required? ❑ Plans Not a Permitted Use in Zone? ❑ Completeness Rezone, Conditional Use, Variance Involved or Required? ❑ Square Footage Commercial Use or Home Occupation? O Occupancy Group 8 Type More than One Residence? ❑ Departmental Releases Adjacent to a Required and Conditions - Shoreline? En. ineerin New Access/Approach? Private or Unmaintained County -Road? Se•a Underground Tank Over 10,000 Gallons Commercial Building Over 12,000 Square Feet? Over'20 Dwelling Units? Over 40 Parking Spaces? Agricultural Building Over 20,000 Square Feet? Landfill or Excavation Over 500 Cubic Yards? Critical Material Designated as a Critical Use Activity? REVIEWED BY:. DATE: Yes No N/A