1985, 07-03 Permit App: 00006253 ResidenceBUILDING 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) D artm Only
LAFKV /,LSE/Ct' F. Comm
I
2 Project Address (not Mailing Address) a Road Name Space Zip
10-24.2./ E. Gcrtgg(t DR 9y'do6
3 City/Community
iPO"(A-Me
State
coo
Subdivision/Plat
hF,
Name
c.Krst Ac 465 aNg APP
4 Assessor Parcel No
^ 16 4'Z ol4/9
Lot
/3
Block
3
+ * ♦ DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. 4
Zone
Project Na. &K-2
6 Dwell 0
1
No. of Buildings
l
Sq. Ft./Acre
Depth
z
vS
Frontage
qct'
7 Set Back-Front(L S-1
3a r 6r 6x,
(R)S-2 1
2. go
Rear
meas Tract
Module No.
InniXials
�1
16 Architect Firm Name I Street Address
NA11 so,J
Zip
City
State
Phone
Contact Person
Phone if different than above
( )
Contractor Firm Name
/IA-W5d A/— CAR-LFn/ Csti-ct
Street Address
N. 5369 Scf LLIO4N ,9/
Zip
'Fla /6
Clty
5Po/IR We
I State
WAl- .
Phone
(509) ?3?-7q1-4
Contact Person
LEw Er
License No.
AiAMSo CC ri iii..
Phone If different than above
( I
8 Owner/Agent lif different than 41 above)
Busi ess Address
9 Zip
City
State
Phone
( I
12 Review Required
Plan Check (Y/N)
Other (Y/N) ISEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
0 Fire
0 MH
0 Demo
X New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work _
10 Applicant Name
Dewey W- N/QA 30A%
Street Address' Q
199 A( .5ci%i(!/AA/ /90(
11 Zip /'
`na(C
City
3A"(Awe
State
1.4/4-
Phone
( lay 1 7a8 -7v3-4
Lender
Street Address
Zip
Clty
State
Phone
Contact Person
Phone If different than above
Additional Information
)1F= j507t
UW : 153.2-14
6A't = 5018 A
El
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; ❑ Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure; Q65'7/
n fin/
APPLICATION # ` 5- d S'7/
Release
Release
w/cond 1
Hold 2
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
Condltions/Comments
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road Improvements �j,/1
Conditions/Comments• �/ Y /a - y �3'
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
Plan Exam
Fire Prev.
7-34
Melfg
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
5TA1 a -v,/ No. 27 .
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