1984, 09-21 Permit App: 00002450 GarageBUILDING 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)
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Department Use Only
Res.
Comm
2 Project Address (not Mai ing Address) or Road Name i j Space Zip -1/-i--
3 City/Community
Sp e R cc j7 e
State
14/a- ,
Subdivision/Plat
14
Name
i c -U I n, Son, % A 0 0
4 As. or Parcel No.
18 S 4 , -
0-2_', �_Z
`(Zone
Lot
Block
* * �r DEPARTMENT USE ONLY * * *
5 Sic Code
Act. #
Zone
Project No.
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
124
Frontage
1c.2`
7 Set Back -Front
(L)S-1
(R)S-2
Rear
Census Tract
I Module No.
Inytials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
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)
c
Other (Y/N)
SEPA Exempt (YIN)
Date
15 Type Work -ice Bldg
❑ Fire
E MH
E Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
!� E --CA c_ ,%Eo G ale_ ck (24-y-2_6)
10 Applicant Name
Pc I'vl,C
Street Address
11 Zip
City
State
Phone /
(5b Y
) 0124 -1 a3
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; I Residential
❑ /New Construction; ❑ Bldg alteration/addition
®/ Additional structure;
APPLICATION # iez /
Conditions/Comments.
Planning/Zoning: ❑ Commercial; ❑ 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.
Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments•
Utilities:
N. 811 Jefferson
Conditions/Comments.
Other:
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Release
Release
w/cond 1
Hold 2
9 ,;It 4
Conditions/Comments.
Planning/Zoning: ❑ Commercial; ❑ 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.
Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments•
Utilities:
N. 811 Jefferson
Conditions/Comments.
Other:
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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