1984, 06-05 Permit App: 00000513 Garage 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(lasts) (first) (m)
Department Use only
,
.. JO #/l 45 oft/ (54,6. -).e. -/-6,1,e ) r
f%s.
Comm
j�
or(//��� Road Name Space Zip
2 Project Address (not Mailing
/Address)
3 City/Community
v� %�G
Stated
G-c)-�f
SuSubdivision/PlatN,anT e ,�-1) (fit' ,
_S.�UG/7 i��)l%i "%7 , I � U. li
4 Assessor Parcel No. i2.J
\
4
22)6 1
Lot
Block
1 2—
* * * DEPARTMENT USE ONLY
5 Sic Code
ne Act. #
Zone
Project No. .t
{ L2
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
!3�'
Frontage
'8'
7 Set Back-Front(L)S-1
(R)S-)(
R ra i
Census Tract
Module No.
Ini
Is
16 Architect Firm Name
J%
/ ✓"XJ
I Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
. Ir _ -/J5'
.4..861,/Z7
Street
Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone If different than above
( )
8 Ownerr//Agent (if different than #1 above)
m
Business
Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan
Check (Y/N)
Other (Y/N)
1 SEPA Exempt
(Y/N)
Date
15 Type Work ❑
❑
Bldg
Fire
❑ MH
❑ Demo
,kf
❑ New
Add/Alter
LI Replace
❑ Move
❑ Other
14 Describe Work A
---/-/2)2/770."(.1
_s��6
C— 6,4,---?_ t7
i
2 ?< ] 3. S ......
10 Applicant Nam )
6k.'
Street
Address r�
11 Zip
City
State
- Phone
Lender A/4
4
Street Address
Zip
City
State
Phone
( )
Contact Person
�/ �- /
Phone if different than above
Additional Information L)
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;
1131. --•Additional structure;
APPLICATION # C3ln ? 4/ 47
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
Ilir"r
10,
Conditions/Comments.
Planning/Zoning:
N. 721 Jefferson
Conditions/Comments.
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Engineers:
N. 811 Jefferson
Conditions/Comments.
❑ Commercial;
❑ drainage
O road improvements
O Residential;
❑ new access/approach;
O Flood Plain;
❑ 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
•