1985, 04-02 Permit App: 00004744 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 (last) (first) (m) Departmen�Only
15 ra.4VN c.,—, "Ter, v-elr RM.
I
Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
g3t4 S 1.•%4 get?) z
3 City/Community
Sere tc A,,.`
State
LA-) A
Subdivision/Plat Name
4 Assessor Parcel No.
iiTit/ -rig) s
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code ne Act. #
Zone
Project No.
6 Dwell #
/
No. of Buildings
L-
Sq. Ft./Acre
Depth
/636
Frontage
�D
7 Set Back -Front
/36
I (L S-1
(R)S-2
1 Rear
Census Tract I Module No.
Initial
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
Sfie kA„.. SrkiAc.1—yews
Street Address
.loco E 5e
Zip
`171_-
City
SQo
State
w A
Phone
(S°q) qz--l-utast
Contact Person
License No.
5v ft I. 0 S I La LA
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work Iiii.. Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
7-4 tt 3 b GArc.Ae /Qekel7he7/
10 AprAnt nt Name
II IIP L`.4d i s
Street Address
G r 5,,� `'`�"
11 Zip
41Ci21 L.
City
S r.
State
5.•.A
Phone
( ) QZ'1—OGS'
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
El
Application Type
(Standard unless
otherwise Indicated)
Fast Track
,.Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
O New Construction;
O Additional structure;
APPLICATION # 0 L 5 1,5
❑ Residential
O Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
•-• -Z-gs
Conditions/Comments.
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size;
❑ CU, variance, zone change; shoreline; ❑
❑ Other
Conditions/ Comments
0 Frontage;
0 use/zone;
fence;
El
Engineers: 0 Commercial;
N. 811 Jefferson 0 drainage
O road improvements
Conditions/Comments'
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions /Comments'
El
Other:
El
ci.
c
o
U
N
Y o O
OS as
E
�, o
`c
LL
Plan Exam
Fire Prev.
Conditions/Comments.
❑
Project Representative
Agencies Performing Special Inspection:
1
Telephone
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold