1986, 05-15 Permit App: 00011074 StorageBUILDING 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) Department Use Only
/1
E WIZ)?j)itti/V 17i FES. Comm
l /4 r I
_
2 Project Address (not Mailing Address) or Road Name Space Zip
p
3 — /.57k L//»?-R,C/r ,
3 City/Community
VER3-d4.LE
State
WA,
Subdivision/Plat Name
4 Assessor Parcel No.
L y 0.-6-W,*
Lot
Block
* * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act. #
Zone
Project No. j 1
0 7 i
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
1 (L)S-1
(R)S-2
f Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Zo II A/ tS . /not a,vee ? f 1;133 t C /AT s
Street Address
I✓- /2,20 to L, E- _spa K. DR,
Zip
CityIIc`I2�
eOl// ibF
State
W4,
Phone �j /
( ) .4,24 � -4%7v
Contact Person
�ouhi.
Phone different than above
( )
Contractor Firm Name
Co O K eivos S7 E,Z- AY.,/y<
Street Address
.-Q1`o 4OG G.ra/('v,`Fw i tP,
Zip
9900'7
City
or,'S 0Rk'Actei.5
State
144,
Phone
( ) 2247-/f:5-7
Contact Person /�
--- i7//h r, COD
License No.
Coo 71 . rr` ,,oQ /q J4,
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N) I
SEPA Exempt (Y/N)
Date
15 Type Work C3.-$Idg
E Fire
❑ MH
❑ Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
34 x _s 7;:ciFA9--
10 Applicant Name
Street Address
11 Zip
City
State
r Phone
( )
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.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
❑ Additional structure;
O Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
1
ILiii
Conditions/Comments.
Planning/Zoning:
N. 721 Jefferson
O Commercial;
❑ Setbacks;
0 Cert. of Exemption;
❑ lot w/d; 0 lot size;
O CU, variance, zone change; shoreline;
❑ Frontage;
0 use/zone;
0 fence;
O Other
Conditions/Comments
Engineers: ❑ Commercial;
N.811 Jefferson ❑ drainage
❑ road improvements
Conditions/Comments.
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions /Comments •
Other:
Plan Exam
Fire Prev.
Conditions/Comments
Project Representative
Agencies Performing Special Inspection:
1
Telephone
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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