1984, 04-16 Permit App: 84A-3390 GarageY-
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)
I s /
(first)
(m)
I Department Use Only
Rss. Comm
2 Project Address (not Mai mg Address) or Road Name
l �
Space
Zip
3 GtylCommunityState
q,ory¢
IV-
Subdivision/ Plat Name
_3rui\s6c_ Aoo l-rLoav
4 Aaseafior Parcel No.
Lot
Block
DEPARTMENT USE ONLY ,t
5 Sic Code
Zone Act. S
Zone Project
Act r—
No.
6 Dwell k
No. of Buildings
Sq. FtJ Acre
Depth
i -75
Frontage
8S
7 Set Back -Front /
0
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
N
Street Address
Zip
city
State
Phone
Contact Person
Phone If different than above
Conn�tr`actor Firm Name
Street Address
Zip
Gty
Stata
Phone
( )
Contact Person
License No.
Phone if different than above
( )
8 Owner/ Agent (if different than M1 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan CheckIts
s
Other(YIN) SE
S
PA Exempt (YIN)
Date
15 Type Work V, Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
A__WRLI:AC0rn AIZA-CA6
10 Applicoat,,Name �'
-e- r-7'--
S /Z:�
Street Address
✓// '�z
11 Zip �/
/
City
%'U
ate
A' _ ,/�
Phone �J
( )
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
❑■
is
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health ❑ Commercial; esidential
W. 1101 College ❑ New Construction; Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION # 30 775 -
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;
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:
�I Project Representative Telephone
Cn Agencies Performing Special Inspection:
Y O 1
►`- E 2
r; o
ca c
U. _
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Release
Release w/cond 1
Hold 2
411 '49
�I Project Representative Telephone
Cn Agencies Performing Special Inspection:
Y O 1
►`- E 2
r; o
ca c
U. _
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
TG
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Scale:
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N. 25 Ntullan, Suite 304,
Spoka,.e, VIA
Phony 15091
c. 'L.AN
922-1690
-----_..-..--------------
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-------------------------------I
ELEVATIONS:
i
-.
y Crown of Street—// 1.-
Finish Floor '—
C� ---------------------------------------
TG
5f
Scale:
-------
t3asic: ; Sq. Ft.� 0 I Legalfl�---/-------------
----------
-
C�DO - 1 i - �- -- ------ ------
--------- - -----------------------------
-------------
Job # /D „Z + Address: '�� Di' c �'// ice' -------------
FHA Case # I --
M,ortgage Co�Q�p�
- --- - ZT
Power co Water Co.
---- ---
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------ —
--- ' Excav
P l u m b I O S
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