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1984, 05-21 Permit App: 00000307 GarageBUILDING 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`(Naaaine (last) (first) (m) ly Ipgpgdm �ar� Comm 2 Project Address (n t Maili Address) v Name Space Zip 6€32Zm/-6e,t`o7) 992/2 • 3 City/Community 40 kCI n r State ,� Subdivision/Plat Name 4 Assessor Parcel No. I564I -0G a.-- Lot Block ♦ r * DEPARTMENT USE ONLY * * 5 Sic Code Zone Act. a _ Zone Project No. c�7s /07 6 Dwell N 1 No. of Buildings 'v Sq. Ft./Acre Depth 156 ' Frontage 74 7 Set Back -Front I (L S-1 (R)S-2 j Rat it Census Tract I Module No. 16 Architect Firm Name I Street Address Zip City State Phone Contact Person Phone If different than above ( 1 Contractor Firm me ---471/31Sety f) podlrn 9 Street Address &322 CAT5sro1 2ip 992/i G6Pok'Ctne StateG�/ 4 Phone ) 9t Z2^023.5— OContact Persons at. roe l)symipst. v' License No. Phone if different than above ( ) 8 Owner/Agent (if different than #1Ave) Business Address 9 Zip City State Phone 12 Review Required Plan Check (YI N) Other el/N) 1 SEPAixempt (Y/N) 1 Date 15 Type Work BldgYY 0 Fire 17 MH New 0 Demo ❑ Add/Alter 0 Replace 0 Move 0 Other - - - 14 Describe Work A &ar433'is 10 Applicant Name S Qn i r.-- Street Address 11 Zip 54411 r, City �'c m— State Phone ( ) — 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 Conditions /Comments DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release' or 'release with condltlons" space prior to permit issuance.) ❑ Commercial; ❑ New Construction; ❑ Additional structure; Residential Bldg alteration/addition APPLICATION # Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone• ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments- Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N.811 Jefferson 0 drainage ❑ new access/approach; 0 fence; ❑ road improvements Conditions /Comments• Utilities: N. 811 Jefferson Conditions/Comments. Other: 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 • Release Icond 1 Hold 2 ';� Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone• ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments- Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N.811 Jefferson 0 drainage ❑ new access/approach; 0 fence; ❑ road improvements Conditions /Comments• Utilities: N. 811 Jefferson Conditions/Comments. Other: 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 • t33.48' S )T 4 (olol.lo'- PLAT (o(ol.°)- MIC‘(NEQ'S REPLA.T, (o(o(.F NTS RE6AR ZS• tto MISSION N' 5 RESAR Z 3.°15 FOUND r4?S QE Sha. 0.3 S 8 0.3"wof Cott. W 1 Oo. rol; LOT 4 AVE E 14%% LoT 3 LOT 3 Lot Z.