1984, 09-12 Permit App: 00002237 Garage, CarportBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this originaland your buliding.plans to the Department of Building and Safety)
1 Owner's Name � / (last) (first) (m)
/Y.L ..a. S v .• ‘,_/...9.4/..- S 4/ -
Department llf6 Only
RBs. Comm
2 Project Address (not Mailing Address) r RodName Space Zip
r- "7672 -St A -JA XGv� L L
3 Clty/Community
State
ce) i .
Subdivision/ Plat Name
�O,y4✓
4 Assessor Parcel No.
/est/L/— aZ39'= 7
Lot
7 1
Block
8 ,* * * .DEPARTMENT USE ONLY * x if
5 Sic Code
Zone Act. a
Zo
a /J Project No.
6 Dwell*
O
No. of Buildings
I i.-
Sq. Ft./Acre
Depth
110'
Frontage
1f ,
3
7 Set Bads -Front I (L S-1 t
7a t 4 1 0
(R)S-2 i Rear
10
Census Tract
Module No.
Initials
16 Architect Firm Name I Street Address
Zip
City -
State
Phone
( )
Contact Person
Phone If different than above
Contractor Firm Name-- //
' Jyiti,FS // NcS S .lcl
/
Street Address
, //1c03 It9/f9'ceJSLG
Zip
9 zo
City
5`f3,,e, rf✓r
State
-G...) .-')/
1
Phone
(may) 92 --?zzc
Contact Person
License No.
Phone If different than above
8 Owner/Agent (if different than e1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (VIN)
Other (YIN) I SEPA Exempt (YIN)
Date
15 Type Work Bldg
0 Fire
0 MH
0 Demo
New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work zo `/`,(` Com/ 6C2 - 77 EA- e t2S 2'!j / „ r
l.at
10 Applicant Name -
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Additional I1formatio
y / "l/Yt,//( / g�/liS..C�L! 16/lllV"'-' !
In,
�I�
a % PX, /Aeet # /6--D/ a T i, 677
/Z/EsSL Y otCDD5 Bo/?/' CcZ 5 '�2(�QC/
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;
❑ Residential
❑ Bldg alteration/addition
APPLICATION #
N.1 -c> SEPT r L o r% �1 (tco'7cr�-c �(
Release
Release
w/cond 1
Hold 2
V1/41/ ft,
Planning/Zoning:
N. 721 Jefferson
Conditions/Coments•
7 p
❑ Commercial;
❑ Setbacks;
9/ CU, variance, zone change; shoreline;
❑ Other
ONNIAltra VW
rk
❑ Cert. of Exemption;
0 lot w/d; 0 lot size;
❑ Frontage;
0 use/zone'
0 fence;
/2/
Engineers:
N. 811 Jefferson
❑ Commercial;
❑ drainage
❑ road improvements
Conditions / Comments•
❑ Residential;
❑ new access/approach;
O Flood Plain;
O fence;
Utilities:
N.811 Jefferson
Conditions/Comments
Other:
plan Exam
ire Prev.
I / 2/g9
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
Scat, : .„^ 5°
fD
GARAGE S'Te Pam
JAMES N• A'ESSLy
PARCEL ° /454/-0239 -
a®'
t(054(-4133
ct./C'----1�
/11