1984, 09-24 Permit App: 00002476 Siding, Soffit, Fasciah; ,B I�G PERMIT APPL CATION WORKSHEET
PLEASEIPRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTANDS.,
,..(Please return this original and your building plans to the Department of Building and Safety)
t Owner's Name .-. Past) (first) (m) lie Only
!Department
tie
Sri < k P.1(� Tho E ,
Comm
2 Pra)ect Address (not Mailing Address) a Road Name Space Zip
F4Sf 95,E Alora _ g9ao6
3 City/Community „
tokaAa—
State
i v A
Subdivision/Plat Name
s
4 Parcel No.
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Slc Code
Zone Act. 0
Zone
Project No 2476
!/
8 Dwell a
No. d Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Bank -Front
(L)6-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Sine I Street Address
Zip
City
State
Phone
Contact Penton
Phone If different than above
( )
Contractor Firm Name
0evo,1. Gro-l�ec5 Cur) fra dors Y c.
Street Address
/J, 31b6 onnz le—Oa-0C
Zip
ggd.enton
styla -/(���-'/'�'}1�/` �, �u
State1,0A
Phone
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V
LicenseNo.
Mc -VA -Y8 - C3L/6m CI
-Phone(sOfira) than
1 ).Sa_rnp .--
8 Owner/ t (Ifinc
W above) Business Address
9
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (YIN)
Other (YIN) I SEPA Exempt (Y/ N)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/ Alter
❑ Replace
0 Move
❑ Other
14 Describe Woork. '1 ', (' ("' /� (' / /
koo-",
Stet SilM iz., £fkF Fasot ,! )
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10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
Lender -
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone if different than above
AddltionaInformation
JrI.C.UA-hm q.3rJ3 CO
P2/i nmil- Po ---11 q6 °i
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N
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DEPARTMENT APPROVALS
•
•
Applicatior,Yype
(Standard unless
otherwise indicated)
Fast Track
Early Start
1 nis is not a rermit
•
(Indicated approvals required In either "release" or "release with conditions"
space to issuance.)
prior permit
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; D Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Comments:
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson ❑ 0 0
drainage new access/approach; fence;
0 road improvements
Conditions/Comments•
•
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments.
IInformation ❑
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