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 •
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MISSION
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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.