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1984, 11-06 Permit App: 00003213 Residence
BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND "sae return this original and your building plans to the Department of Building and Safety) 1 i'sa se (last) (first) (m) EDepartment'Onty chs el D. R'Co Vin ("TrRt11Tr e'Comm 2 Project Address (not Mailing Mdreee) or Road Name Space Zip T,nrPtt-a Pnri,c1 S 374/ 9', 2-6 3 City/Community Snnlrr,nA State a. Subdivision/Plat Name Ki_( 2 1 c -i-10 -1''c9 1dc1i tion 4 /.5seesor Parcel Ng. `7n 5L / - 2 G Lot 6 Block Li * * * DEPARTMENT USE ONLY * * * 5 Sic Cade I Z rat M Zone _ SFS Project No. � 52 / i 6 pvctl1 / No. of Buildings / Sq. Ft./Acre Depth /28.6/ Frontage i62.5o 7 Set Bads -Front 37 (L 8-1 2O (R)S-2I 30 �50 Census Tract Module No. Initials r.;114/"..) 16 Architect Firm Name T) TT _ A _ Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name hi n1-,an1 i'rr(Tr^':11 Cn_ru, 1:,-- Lap L an Street Address Vii_ y "2J L n_L nrter Zip 9920h City - 1, n State a _ _ Phone ' (rye �) ��c_1 C �% Contact Person t 7.741? -fa TJ^n ar_l f h License No. ? ')3,...L1 ',,Tr+ r i !`• 1\T,'j')7 5u') )l! Phone if different than above ( ) _ 8 Owner/Agent (if different than a1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/ N) Other (Y/ N) ESEPAExemPt(Y/N) Date 15 Type Work 0 Bldg 0 Fire 0 MH 0 Demo d' New 0 Add/Alter 0 Replace 0 Move 0 Other 14 Describe Work c1;„aes.i_c'len.tial rf/CC,1Pd C<trir E', 10 Applicant NarYtel Elc:�.ae1_ D. TTc sr-th Street Addess S. 1_;_6c_;_ Van rtarter 11 Zip 6 City n ane State .f ' Phone ( 5 Q) n2- 97 Lender '. :0ST-).71:'to 1 ' 'tu_ al Sit rsrs Street Address i T.I. 601 Ti,ain Zip 90201 City ,--“Tin' ne State !r . Phone (r.-0(-.; ) L55- Contact Person Phone if different than above Additional Information PM/4 Q{pp©Ved bGJ a -Po g[.�FFiitr A! eW O6 f�.�1�- A1p 1t1L J8 /f 2O C�14 le 5-2o (lel' k /Ve5 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 Conditions/Comments. ❑ Commercial; ❑ New Construction; ❑ Additional structure; ❑ Residential ❑ Bldg alteration/addition APPLICATION # gids Release Release w/cond 1 Hold 2 Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments. Engineers: ❑ Commercial; ❑ Residential; N. 811 Jefferson ❑ drainage 0 new access/approach; 0 road improvements Conditions/Comments. ❑ Flood Plain; O fence; / Utilities: N. 811 Jefferson Conditions/ Comments• 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