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1984, 10-19 Permit App: 00002943 Garage, PatioBUILDING 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) / /p .(last) first) •/(m) I 1 L[y-"�% _I/ Department Use Only R3s. Comm 2 o(ect Address (not Mailing Address) a Road Na a Space Q Zip /l718' 29/a ,.... 4,2. r....„-...„ .t. 3 City/Community 5pip 4� SuDOlvlsion /Plat y Q� rMo9 m (97-- �- (YJZr�`T M1 >/��r�,rn✓ 1" T 4 4 Assessor Parcel No. /f) 5 2 -. 0x7 04 - ,/5 Lot 4 Block I ♦ • : DEPARTMENT USE ONLY * * * 5 Sic Cod/ a Zone Act. If Zone rn I , Protect No. ^ r 6 Dwell* I No. of Buildings Sq. Ft./Acreth SIFrontage 1 I 7 Set Back -Front 2St (L)S-1 --. (R)S-2 'Rea— Census Tract Module No �tla7ls m 1\1 - UU 16 Architect Firm Name_- - - - - — - - _ - I Street Address , f Zip — - — - _ . _- City - State Phone . 1 1 Contact Person - , — - — _ Phone If different than above 1 ) Contractor Firm Name — -- Street Address Zip - City State Phone Contact Person License No Phone if different than above ( ) i 8 Owner/Agent (If different than et above) Busi ess Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) I SEPA Exempt (Y/N) Date 15 Type Work ❑ Bldg 0Fire ❑ MH 0 Demo 0 New 0 Add/Alter 0 Replace 0Move 0 Other 1 14 Describe Work '4)t 6b /7/4/E 11 K10.PA ` 0 10 Applicant Name Street Address 11 Zip City State Ph 7(22 5 / g-ir 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 Environmental Health W. 1101 College Room 200 DEPARTMENT APPROVALS This is nota Permit (Indicated approvals required in either 'release' or "release with conditions" space prior to permit issuance.) ❑ Commercial; ❑ New Construction; ❑ Additional structure; ❑ Residential ❑ Bldg alteration/addition Release Release w/cond 1 Hold 2 20 (ifi APPLICATION # Conditions/Comments 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 Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence; O road improvements Conditions/Comments Utilities: N. 811 Jefferson Conditions/Comments' 0 Other: 0 Plan Exam Fire Prev. Conditions /Comments• Protect 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 t ■■■ . ■■■ .■ . .■. ■■ ■■ ■■ ■ ■ L /, 1I ?i ck.1 _■ sa . 44/ CO •' ; / /_i�Q�it ii j� BOO ' /.:IL — — t ITF �r _!-_L 1