1984, 10-11 Permit App: 00002803 Garage, CarportVi3 `(2o
• •
BUILDING 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) Use Only
IDeparlment
MCKu,GAIT Com us -'o F Pas. Comm
2 Project Address (not Mailing Address) a Road Name ' Space Zip
s: 11 1(0 %--f OM 6sTEA-D C7,
3 City/Community
VEgA°ALC—
State
WA
Subdivision/Plat Name
RoTcwFof2D /JrcRC- Ilz..CTS
4 Assessor Parcel No.
Z1 S4 S — 2_3
Lot
�3
Bock
* * * DEPARTMENT USE ONLY * *
5 Sic Cade
Zone Act. 0RTMEN•
Project No.
9n2/
6 Dwell 0
No of Bull inge
Z
Sq. Ft./Acre
Depth
�6 I I
+
Frontag i 1
7 Set Back -Front
eXI9-n
Nice,
(L)S-11-2
9S I
—
Rear
s `
Census Tract
Module No.
Initials
JOS m .
16 Architect Firm Name I Street Address
Zip
City
State
Phone
( 1
Contact Person _
Phone If different than above
( 1
Contractor Firm Name
Yn`' cry) I tq C.0 nn -1 n/
Street Address
P. 6_ Bo X .24 o
Zip
'qav(
City
State
Phone
( ) ale --- 4CC,g
Contact Person
License No.
Phone If different than above
)
8 Owner/Agent (if different than 01 above)
Business Address
9 Zip -
City
State
Phone
1( 509) 9 -2-` - 3 9 n
12 Review Required
Plan Check (Y/N)
Other (Y/N) ISEPA Exempt (Y/N)
Date ,
15 Type Work i% Bldg
0 Fire
❑ MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work 24 X4 �K"v'o '✓ l
2 � 11 X2�
10 Applicant Name
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone d different than above
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
O Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
APPLICATION #
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
Conditions/Comments
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
O road improvements
Conditions/Comments-
Utilities:
N. 811 Jefferson
Conditions/ Comments•
Other:
111
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