HomeMy WebLinkAbout1984, 05-29 Permit App: 00000341 ResidenceBUILDING PERMIT APPLICATION WORKSHEET Jv D°
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 ( fl stl Iml
Depart rtre (e Only
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2 Protect irV I ( M� � A )! / / ,e�,, .V [ Space Zip
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3 Gty mmunity
State
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4 /t� rParcel C / No.
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Lot
Block /
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.N
Zone 51VV
Project No. .2�}
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6 Dwells
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No of Buildings
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Sq. Ft./Acre
Depth I
1 q0
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70 .
Set Back -Front
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Initials
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16 Ilea Firm Name Str dress
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State
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Phone
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State
Phone
Contact n
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Lic se No.
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Phone if different than above
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S Owner/Agent(if differen nM1 above)
Busl ass Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (Y/N) 1 SEPA Exempt (Y/N)
Date
15 Type Work /'t�i8ldg
/
0 Fire
0 MH
0 Demo
X!New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
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10 Applicant Name ' .a
Street Address
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11 ZIP /2,-, I
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State &4 ,) 7c01 ----SC , P
Lender
Street Addr�ess3K'•JrL(1 .
Street
Zip
City
State
Phone
Contact Person
Phone If different than above
Additional Information
n1.F . = °18v R( 2 4-12 -
U&' z1E7o# 2 F 11
li,(< = 6 X lo - bcils
&pen_. = -2.4 )(-2/1/ = 527
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
DEPARTMENTAPPROVALS
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
Conditions/Comments
❑ Commercial; ❑ Residential
❑ New Construction; 0 Bldg alteration/addition
❑ Additional structure;
APPLICATION #' go Slf 1
(vat 04,0-7 4-- 775/-
Release
Release
w/cond 1
Hold 2
Planning/Zoning:
Planning/Zoning: ❑ 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;
O road improvements
Conditions/Comments-
Utilities:
onditions/Comments-
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
O
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
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