1984, 07-09 Permit App: 00001048 StructureI,
TO
BUILDING PERMIT APPLICATION WORKSHEEtT ✓ '
• 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)
L L.
irst)
(m)
Department Only
Ras. Comm
2
Project Address (not Mailing Address) or Road Name
I,40Z h ju ),q
Space
Zip
3
4
Gty/Community
(- ig k-?�
Ass6kaor Parcel No.
State
til.► ilz)
Lot
�+
Subdivision/ Plat Name
tA k un 19LLS !
Block
* * * DEPARTMENT USE ONLY
ode
neAct. M
Zone�TT-Project
No.l
M
No. of Buildings
(
Sq. Ft./Acre
Depth
13-7 (qack-Front
Frontage
F5SIC
(L)S-1 t
(R)S-2
Rear
I�D
Census Tract
Module No.sitect
Firm Name
Street Address
City
State
Phone
Contact Person
Phone if different than above
Contractor Firm Name
ALL.
✓PICS
Street Address
V'� ����,��(�
9924
Zip
City
�x 0 v�C
State
(.tJ 1�
Phone
(,-6�' 9 z � - 1 �
ntact
ill,
License No.
►�
- r�
ph
Phone if different than above
( '
8
Owner/ Agent (if different than M1 above)
Business Address
9
Zip
City
State
Phone
12
Review Required
Plan Qhpck (YIN)
Other IN)
SEPA
Exempt (Y/N)
Date
15
Type Work
P- Bldg
❑ Fire
❑ MH
❑ Demo
[;.Ptew
ElAdd/Alter
❑ Replace
❑ Move
❑ Other
14
Describe Wo
1=1t
Name
Street Address
11 Zip
City_
State
Phone
Lend r
V wt
► r�
e- 0 LC & s
Street Address
oc) q o -,7 k7 �
Zip
q9 12-d
City
State
-
Phone
( X22
Co_ntya�ct PJ.er I
t ,c11
Phone if different than above
Additional Information
20 p 7�(
7,0 0
{v
v
-Z -3 ?,
of
791
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
I nls is not a Hermit
Application Type
❑
(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
❑ Commercial; ❑ Residential
W. 1101 College
❑ New Construction; ❑ Bldg alteration/addition
Room 200
❑ 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;sidential; ElFlood Plain;
N. 811 Jefferson
❑ drainage new access/approach; ❑ fence;
❑ road improvements
Conditions/ Comments:
❑
utilities:
N. 811 Jefferson
Conditions/ Comments:
❑
Other:
Plan Exam
Fire Prev.
l 2�
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