1984, 04-26 Permit App: 00000063 Garage AdditionBUILDING 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)
---.),1e/e1 Owner's Name -• (last) ' . (first) (m) Department Use Only
1� _. .___ _. _ 1�-' \ C_i�'(�12C]- :_' : : E. - Ras. Li/Comm
I
2 Project Address (not Mailing Address) v Road Name -' Space Zip
fd • 14-S°5: tic 12_07 ggia1.0
3 GN/Community
"r-nnv-6-
State
• U'h"
Subdivision/Plat Name _
-Th14- P c FtTzrPAte-1c.i�5 Stc3..
4 Assessor Parcel No.
z_ �v1 6q
C2 -54-2--
G
Lot•frock
7 q S.
4 ♦ + + DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act. MT
Zone
OLA1` n l Project No.
6 Dwell II -
No. of Buildings
Sq. Ft./Acre 5
n
_ Depth
Frontage
7 Set Bads -Front r 18-)S-1
(R)S-2
Rear /
fEruus Tract
Modt4g.No.
I s
r 16 Architect Firm Name - " I Street Address
1' vPt — - ....._ _
Zip
GN
State
Phone
Contact Person
-
Phone If different than above
( )
Contractor Firm Name/
, 1\ji pc—
Street
Address
Zip
1
GN
State
Phone
( )
` Contact Person -
License No.•
Phone if different than above
( )
8 Owner/Agent (if different than 01 above)
Business
Address
9 Zip
City
State
Phone
( )
12 Review Required +,
Plan Chegk (Y/N)
�❑
Other (Y/NN)
I SEPA Exempt
(Y/N)
Date
15 Type Work p -"Bldg
0 Fire
MH �b
0 Demo
yew
Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work .
40 0 -ra C 44(2c .rs
10 Applicant Name.
6-
Street
Address
11 Zip •
City •
State
Phone
(5°1 C 2 -4471r -$Sol.
Lender
Street Address
Zip
City ..
State
Phone
Contact Person
Phone if different than above
( 1
Additional Information
DEPARTMENT APPROVALS
•
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
1 nis is nota Permit
(Indicated approvals required In either "release" or "release with conditions'
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
Environmental Health ❑ Commercial; Q sidential
W. 1101 College ❑ New Construction; Bldg alteration/addition j�y7/4
Room 200 ❑ Additional structure;
(/
APPLICATION # ���/Are
Conditions/Comments
Planning/Zoning: 0 Commercial; ❑ Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone
❑ CU, variance,. zone change; shoreline; '-❑tfence;�� •
0 Other
Conditions/Comments
•
Engineers: 0 Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments
t;
•
Utilities:
N. 811 Jefferson
Conditions/Comments•
0
Other:
Plan Exam
Fire Prey.
-
Conditions / Comments•
Project Representative Telephone
Agencies Performing Special Inspection:
1
' Informati,
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Lf ,