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1985, 06-17 Permit App: 00005982 Garagen 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) 4m)` Dprtment.Use Only (/f�©©©� ////C Ee �1]/, fes' ��/// Comm I 2 Project Address (not Mailing Address) a Road Name Space Zip 3 City/Community ..:NjLB/e.R.vE' 1 State - arVet - Subdivision/Plat Name C14 //S A9,12 / 77 4 Assessor Parcel No. /55'9 <///7 JJ JJ 77 Lot Block t f + DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. 4 ZoneA/ c� 11l J 13v Project No. 5q3 ^ / 6 Dwell # 1 No. of Buildings Sq. Ft./Acre Depth 2OO Frontage -Ts I 7 Set Back -Front ., I (L)5-1 • 110 (R)&Rear r �50 Cel sus Tract Module No. Initials �f , 16 Architect Firm Name I Street Address Zip City State Phone Contact Person Phone If different than above Contractor Firm Name Street Address Zip City I State Phone 1 ) Contact Person License No. Phone if different than above 8 Owner/Agent (if different than p1 above) Business Address 9 . Zip City - State Phone ( ) 12 Review Required Plan Check (Y/N) "4-I. Oth r (YIN) [ SEPA Exempt (Y/N) Date '15- Type Work Ai Bldg 0 .Fire 0 MH 0 Demo X New 0 ACO/Alter 0 Replace 0 Move ❑,Other 1a Describe Work ' 7Gcic‘c-t-kso Cm far rzAcet C3oK4o) 0 Applicant Name `4 lic�Ds. /WWl'ftec eel-- Street Address drew et 401 ric. 11 Zip ` aa(Co City 5/70(-6-1-4.4.,w(l, State - Phone (s o7.., 9 7 (.e I 1 Lender Street Address Zip City State Phone Contact Person Phone it different than above Additional lnfor tion 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 Conditions/ Comments• ❑ Commercial; ❑ New Construction; Additional structure; PLICATION q ❑ Residential ❑ Bldg alteration/addition -J V Release Release w/cond 1 Hold 2 QZ 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, varlance, zone change; shoreline; 0 fence; O Other Conditions/Comments' 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/Com ments• 111 Other: Plan Exam Fire Prev. Conditions/ Comments• PAU-Pt IL Se D S Loa/ ecc/U6r2 ScaJccs•t° ?trsc_c� Uc2tFtc4(3TLo/C 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 a --. / (a z. c. I/1 il .. O e .0 t J"1*i Pols- elgolvc,` LmAs' Cove f o o 1 I?' 61-1•21100 Coot o' Wort ENO y t �. :7-5-3