1985, 04-04 Permit App: 00004778 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)
Owner's Name (last) (first) (m)
Dapenrrentlke Only
W1
j ,,
e./4/r r Lr /o Pin 0
RC. V Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
/0a-/-7 5' /4oL144ut, kd
3 City/Community
State, ^
1f�N.
Subdivision/Plat Name
_ELLE. r1 t -t, 6—I
4 Parcel No.at:)f4gA/.0
D5 4-4 i - D90 (
Lot
b
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. 4
Zone
7{'''�{ ,+ s Project No
IS/7Ig
6 Dwell II
No. of Buildings
Sp. Ft./Acre
Depthe� '`
2LN1
Frontage
I8o 1
7 Set Bait -Front
X(@fNGI
(45-1
(R)S-2 I Pear
_
Census Tract
Module No.
Initials
16 Architect Firm NameStreet Address
60‘4.../4/-P 2 I /o z Pt E . H01-vif n.v 2cl
Zip -
City
State
Phone
( ) 72 - 7r3
Contact Person
Phone If different than above
( )
Contractor Firm Name
,e2Gva//e 2, / Sgox e (ac 4AO0 e- )
Street Address
Zip
City
Stat
Phone
( 1
Contact Person
License No.
Phone If different than above
( 1
8 Owner/Agent Of different than 41 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check re/ N)
Other (Y/N) ISEPA Exempt (Y/N)
Date
15 Type Work 0 Bldg
0 Fire
0 MH❑/New
❑ Demo
W Add/Alter
0 Replace
0 Move
❑ Other
14 Describe Work i
10 Apli nt Name
70 11-7 We7,t/`c (c
Street Address
o i NoLa,Sav kr/11
Zip
City
Sp,'agwc
State
WR.
Phone
(5`'S) 929 —753/
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
Additional Information
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;
O New Construction;
❑ Additional structure; 2
APPLICATION #dg13 4 J
❑ Residential
❑ Bldg alteration/addition
Release
Release w/cond 1
Hold 2
nour
Conditions/Comments'
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments
0
Engineers:
N. 811 Jefferson
❑ Commercial; 0 Residential; 0 Flood Plain;
❑ drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Com ments•
0
Utilities:
N. 811 Jefferson
Conditions/ Comments•
0
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
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