1985, 06-04 Permit App: 00005740 Storage BldgBUILDING 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)
Cepartment Use •nly
�11
S'40 A•444 0 N 7(7E4 A% P. r
Fi3S Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
F, 1.,/"").3" Avlxuse// Ave 99a.er6
3 City/Community
SPSf!Aw>n - OPP.0interAb f1/
State
11.)06y7..
Su son/Plat Name %�
ISSi0 i IRNe�
4 Assessor reel No
//r1/4 — C/2 `_
(UJ L V
L t I Block
4 * * * D PARTMENT USE ONLY * * *
5 Sic Code
Zone Act. A
Zone
Project No.
6 Dwell #
i
No. of Buildings
3
Sq. Ft./Acre
Depth
/6,-71/4
Frontage
I cis
7 Set Back -Front I(LB�
II
(R)S-2 ER�
I
Knaus Tract (Module No.
Initials / ,
l/35 CSJ
16 Architect Firm Name - Street Address
Zip
Zip
City
State
Phone
1 )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City
Slate
Phone
( )
Contact Person
License No.
Phone If different than above
( 1
8 Owner/Agent(if different than 91 above)
Busi ess Address
9 Zip
City "
State
Phone
( ) 924-
12 Review Required
Plan Check (YIN)
Other (Y/N)
f'/7')
SEPA Exempt (YIN) Date
I
15 Type Work e( Bldg
❑ Fire
❑ MH
❑ Demo
Er' New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
2SS �d 5TOPAOE I.&LOCA
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone d different than above
( 1
Additional Information
DEPARTMENT APPROVALS
El
•
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
This is nota Permit
,
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
Release
w/cond 1
Hold 2
�f
rJ
Environmental Health 0 Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration /addition
Room 200 0 Additional structure;
�,,R.ellease
tvr- „�
`C)QLiQ
f8k
APPLICATION# /CDSC
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 0 new access/approach; 0 fence;
❑ road Improvements
Conditions /Comments'
Utilities:
N.811 Jefferson
Conditions/Comments'
•
Other:
Plan Exam
Fire Prev.
Conditions /Comments:
1 Information ❑
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
I
E
/17 E