HomeMy WebLinkAbout1984, 30-30 Permit App: 84A-3213 Barn4
BUILDING 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 (last)
Dl .^&-
(first)(m)
M
/ Ifr e L
Department Use Only
:8s. Comm
2 Project Address (not Mailing Address or Road N} me
N2a& S �oN22L
Space Zip
3 Cly/Community
d>S�o K.A` (z
State
I
Subdivision/Plat Name
�6N"�2P �Uf�Es
4 Asswwr Parcell No.
32.54+— 11 14-
Lot
Block
♦ t + DEPARTMENT USE ONLY ♦ f
5 Sic Cade
Zona Act. M
Zone
Project No.
6 Dwell#
>a
N. of Buildings
Sq. Ft.I Acre
Depth
Z2S
Frontage
(l4-
7 Set Beck-FrCM (L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
city
State
Phone
Contact Person
Phone if different than above
Contractor Fir ame
M X4.,, 141 C'C3 7
,,
Street Address
13a,?l � .7
Zip
city
State
Phone
lfl L Dntact Person . 0/✓ M 'Q4:s rrf l�
License myNo. FQm ^ 17C •-5
1... l b./
Phone different than
��U ��� 7
B Owner/ Agent (if different than Ml above)
Business Address
9 Zip
City
State
Phone
( 1
12 -Review Required
Plan Check (YIN)
1v
Other /N) SEPA
. `4is
Exempt (YIN)
' m—,
Date
15 Type Work Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
G -4r � L
10 Applicant Name
SSC M L
_
Street Address
11 Zip
City
State
Phone
( 1
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( 1
Additional Information
DEPARTMENT APPROVALS
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
i
This is not a Permit
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 wlcond 1 Hold 2
Environmental Health
W. 1101 College
Room 200
❑� ommercial; ❑ Residential
12'New Construction; ❑. Bldg alteration/addition '
❑ Additional structure; 3Eo�S(
APPLICATION If
Conditions /Comments:
El
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:
El
Engineers:
❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811Jefferson
❑ drainage ❑ new access/. approach; ❑ fence;
❑ -road improvements
•-
Conditions/ Comments:
Utilities:
N. 811 Jefferson
Conditions I Comments:
El
Other:
- -
Plan Exam
'
Fire Prev.
"
Conditions I Comments:
Project Representative
Telephone
Agencies Performing Special Inspection:
0
1.
W
E
`o
2
`c
3.
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
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