1986, 02-25 Permit App: 00009792 GarageBUILDING PERMIT APPLICATION WORKSHEET
j 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)
' t / ✓
Department Use Only
Res.
Comm
2 Project Address (not Mailing Ad .<-) a Road Name/ Space Zip
,?03 hre-C � 97.Pd6
3 City/Co unity
State �f
(A -s It
SubdivlsionlPlat Name
. /I�/(('i.I IY) C. �=Ij — if (A Tz.
4 rel No. Lot
I _ 0( Co
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. 4 Zone (4
No. 61 7 9
61
6 Dwell 4
No. of Buildings
/
Sq. Ft./Acre
Depth /
.9°7`...
Frontage
3c
7 Set Back-Front(L
� %t
//
S-1
Li ?
(R)S-2
1
Rear
Census Tract
Module No.
Initials
Ali I•v`
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Co ctor Firm Name /
Street Address / /
Zip
Gty4
State J
Phone
act PersonLi
s/�No.�)
Phone If different than above
8 Owner/Agent (if different than 41 above)
Business 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 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work '
CSP-( FE- 2q X Z -d ,
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 1 rmation
!T! ‘ i r) C x„/ / `”
.( `' e % /.21 el lJ;<-4.,-___
DEPARTMENT APPROVALS
❑
•
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
1 his is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
❑
Environmental Health ❑ Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
,2(5't
tSOCrck. I
APPLICATION# ? —el/60
Conditions/Comments•
❑
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments.
❑
Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson ❑ drainage 0 new access/approach; 0 fence;
0 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