1985, 06-14 Permit App: 00005949 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 Name ast) (first) (m)
PA
Departmen .Use Only
Ras. Comm
2 Project Address (not Mailing Addr as) or Road Name Space Zip
1
3 City/Community
State
wf
Subdivisio rl(P� t Nameo
P
4 Assessor Parcel No.
ZZ� 0
Lot
O
Block
IJ
tr rr ,t DEPARTMENT USE ONLY
5 Sic Code
Zone Act. N
Zone /+ Project
No.
6 DwelI#
No. of Build' s
Sq. Ft./ Acre
Depth
Frontage
7 t -Front
(L)S-1
S I
(R)Si2
R=r
Census Tract
Module No.
Initials
JON
16 Architect Firm Name
Street Address
Zip
Gty
State
Phone
( I
Contact Person
Phone If different than above
Contractor Firm Name
d AV JL
Street Address
744
Zip city
State
Phone I IF
)
Contact PersonLicense
lie
No.
Phone if different than above
6 Owner/ Agent (if different than k1 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (Y/ N)
Other (YIN) SEPA
Exempt (Y/N)
Date
15 Type WorkBldg
Ze
❑ MH
El Demo
ew
ElAdd/Alter
❑ Replace
El Move
❑ Other
��❑:1
14 Describe Work &%AV's -7"b
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 Information
f:
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application Type
This is not a Permit
❑
(Standard unless
otherwise indicated)
Fast Track
(Indicated approvals required in either "release" or ^release with conditions"
space prior to permit issuance.)
❑
Early Start
Release
Release w/cond 1 Hold 2
Environmental Health
W. 1101 College
Room 200
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
❑ Additional structure;
APPLICATION #
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; ❑ fence;
❑ Other
Conditions/ Comments:
❑
Engineers:
❑ Commercial; ❑ Residential; ❑ Flood Plain; L -T
N. 811 Jefferson
❑ drainage ❑ new access/ approach; ❑ 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:
C
1,
O
E
2
o
c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Alm."
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