1984, 05-01 Permit App: 00000615 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)
1 Owner's Name past) I'�\c (first)'''1(m)/Use Only
IDspertmant
yy,,
LA 6i� U QC!l ( h� rG Poe'
Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
,10 JI FA,+ fii ra r,v 9 902/g
3 City/Community
5 Kpi!✓
State
LoA-eh
Subdivision/Plat Name 'Auto
i)Aa 1A)CAYrNtS AOQ.to'Auto\wow&i
4 Air Parcel No.
6SCP-1 — (Zt,
Lot Block
* * ♦ DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act."
Zone Project No.
jZ 6 DweII a
I
No. of Buildings
'2—
Sq. Ft./Acre
Depth
% SO'
Frontage
I zor
7 Set Back -Fran) 1 - (L)5-1
2W sx/5c
(R)S-2 Rear
Census Tract
Module No.
5
Initialsex7s;.
)"
16 Architect Firm Name - I Street Address
Zip
City
State
Phone
1 )
Contac Person
Phone If dllferent than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
'( I
Contact Person
License No.
Phone If different than above
I )
8 Owner/Agent (If different than 41 above)
Bus! ess Address
9 Zip
City 1
State
Phone
12 Review Required
Plan Check (Y/N)
if;Fa
Other(Y/N) I SEPA Exempt (V/N)
4ES
Date '\
15 Type Work 1/Bldg
0 Fire
0 MH
0 Demo
0 )lew
W. Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
ADO not o aU `To nk_E.S t OENC-E — 1 It VIt hM cynic. bt '
10 Applicant Name 7
f�\l
EA )) L h JR/O
Street Atlrss
n2 I ?, I A)
11 Zip -
9g(A
City
pi) knit) E,
State
i,)nl,In
Phone
(5°9) 9r;
2-1- 6 46 i
Lender
�r��ln \ 100-11n /0 `('frau -r
Street Address
jl f City o k A ut
U\ I
State D R S�
GD
Phone
Contact Person
Phone If different than above
( I
Additional Information ,,/,
4804' Mto 7 N 6
ZISO Irk (re
Application Type
(Standard unless
otherwise indicated)
Fast Track
i
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 ' 0 Commercial; eiLesidential
W. 1101 College 0 New Construction;zr Bldg alteration/addition
Room 200 0 Additional structure;
. APPLICATION #
4-14387-
MIL
Release
Release
w/cond 1
F
Hold 2
171
Conditions/Comments •
O
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 -
O
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions/Comments'
Utilities:
N.811 Jefferson
Conditions/Comments•
d
d
Ij
Other:
Plan Exam
Fire Prev.
Cond ltions /Com men is4r•
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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