1984, 06-19 Permit App: 00000728 Relocate Storage BldgBUILDING 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)
//2s T t)e h-, Ze e-eve-//i9BA. er
Department Only
Res. f/
Comm
2 Project Address (not Mailing Addr �r Roaa Name Space Zip
r. �r 0.2_, ` '�'..,. ?%2_
3 City/Community
...5;00 6 .0 eo. AJ
State
Zti:e..-
Subdivision/ Plat Name /
(� e Chi 4 /Z-.1 U P ,
4 Aur Parcel No.
0-75-4-2 _ ,2 __ - f
Lot
Block
* + . DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. N
Zone
Project No.
72-'1
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Bads -Front
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
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 #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
l OZC-E-i 1v11/Jd Lt -t, C1- �i , L,g-4 �c-moi 1
10 Applican e) �/ r
/
Strdd� 4-- /fc%
11 Zip
a /�
City
s.,/
�4d�'
r Phone /
D/j �� F -- . d C,(-
o f�
Lender
Lender
Street Address /
Zip
City
State
Phone
( )
a
Contact Person
Phone if different than above
( )
Additional Information4
-;%Oc00
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
y❑ mmercial;
❑ New Construction;
Additional structure;
Residential
❑ Bldg alteration/addition
APPLICATION #
Conditions/Comments
Planning/Zoning: LI Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions /Comments •
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions/Comments•
O Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
ci.
Plan Exam
Fire Prev.
Conditions /Comments:
Project Representative
Agencies Performing Special Inspection:
1
Telephone
2
3
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Release
Release
w/cond 1
Hold 2
LAN C- k--•
APPLICATION #
Conditions/Comments
Planning/Zoning: LI Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions /Comments •
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions/Comments•
O Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
ci.
Plan Exam
Fire Prev.
Conditions /Comments:
Project Representative
Agencies Performing Special Inspection:
1
Telephone
2
3
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
'I
M