1984, 06-05 Permit App: 00000516 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 Owners Name(first) (m)
�parimsnt the Only
-(laasst)) ' l
ri,uaeRvlr3Al V �N
Ras. Comm
2 Project Address (rat Mailing Address) or Road Name Space Zip
£ /1725- L e,J0t.9 Die, 99-zo‘
3 City/Community
tSYnXlit.Av
State
/�/
Subdivision/Plat Name
5- K Of A c.
4 Asses-
Lot
BlockO y 7
* * * DEPARTMENT USE ONLY * * *
c44 - - 0-7�
5 Sic Code
Zone Act. li
Zone
A S
Project No
��
6 Dwell 0
No. of Buildings
Z
Sq. Ft./Acre
Depth
11 I
Frontage
IOCo
7 BadCIF�r.
I (L)S-1-1 )`,
II
(R)S-2 rRea I
it
Census Tract (Module No.
Initials ^^ ,
/V1 ' I 1
16 Architect Firm Name Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
Contractor Firm NameStreet
Address
.f/ 05—Sl /di1 /,e`g-T
/V %Z J ST. L ,pD (//Ld,,A s
Zip
9.9/0 7
City
Siad l9Aie
State
/(.et
Phone
(vo9) 4/?4,-2a0,2_,
•Contact Person
/)L /,U/2 -J'/
License No.
/47--24-S<Sr-/929X
Phone if different than above
( ) ,S44ae
8 Owner/Agent (If different than sl above)
Business Address
9 Zip
City
State
Phone
( )
.--
12 Review Required Plan Check (Y/N)
Other (Y/N) I SEPA Exempt (V/N)
Date
15 Type Work >< Bldg
0 Fire
0 MH
0 Demo
`Vi New
/❑ Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
CDA/rr)-ucr ?o )( V O �K /Z ' S7o.liF6W 6204 lel Cie°,
10 Applicant Name
A71J tn.-rev-filter
Street Address
/1,9,54 --?z .fi ecr
11 Zip
(792-6'7
City
Sho e
State
ZO4
Phone
(09) 4/1-9-2a2_
Lender
Street Address
Zip
City
State
Phone
' 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.)
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
- 0 Additional structure;
❑ Residential
D Bldg alteration/addition
APPLICATION #
Release
Environmental Healthe441
Release
wlcond 1
Hold 2
Conditions/Comments•
.A
D
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;
O 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:
Pian 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 Indkate above or attach reasons for, hold
waiwp 7
4;c6c0
ivEw STd kmae
By Lch NL,
i\