1985, 04-24 Permit App: 00005106 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
'/ l' (last) �/(first) (m
4 n10 -e / - -h Oe I
Use
Department Oply
IS. Comm
2 Project Address (not Mailing Address) a d Name Space Zip
70 & l orA- Ave__ geiza
<
3 CityICnmmunity
C POkrtN� - .
Stat
�
Subdivision /Plat Name
.catt11;4 PISA . -Po-
d Assessor P.c75‘le No. - 601 - ` Lot
/ 3
Blau
i y t DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. SI
Zone
Zone I_u b -
I Project No. •
O
8 Dwell, /
No of Buildings
Sq. Ft./Acre .'
6'C-'
Depth
Frontage
7 Set Back -Front (L)S-
(R)S-2
Rear
3
Census Tract
Module No.
Initials H�
lG-
16 Architect Firm Name 1 Street Address
Zip
City • -
State
Phone '
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone If different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
(50'?) q2 a- 174043
12 Review Required
Plan Check (Y/N)
Other (YIN) I SEPA Exempt (YIN)
Date
15 Type Work Le...Bldg
0 Fire
0 MH
❑Demo
I'New
0Add/Alter
0 Replace
0 Move
0 Other
14 iC IZ4DefoI hed citi-40_a
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
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATION
Conditions/Comments. L C
❑ . Residential
❑ Bldg alteration/addition
•
R- easy
Release
. Icond 1
rriltiailarMni
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone.
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Cond It i ons /Comments •
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
• ❑ road improvements
Conditions /Comments
0
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
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
ert-
N
5z
1 , t ; / • i .
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