1985, 03-28 Permit App: 00004676 Garage BUILDING PERMIT APPLICATION WORKSHEET
"62/
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 Na (last) A (first) (m) Department a Only
a .....4)
r J""
Res. ` Comm
2 Project ress(not Mailini Add )ar Roa Name Space
40)g you - of
3 City" •mmunity Stat Subdivision/Plat Name
40l//_ �% a . See 6he�� LP0a/
Assessor Parceypo. I Lot Block
` * * * DEPARTMENT USE ONLY * * *
.6)s5 2 al-2
5 Sic Code Zone Act.0 Zone A Project No. �
E1r , I���
6 Dwell 8 No.of Buildings Sq.Ft./Acre Depth / Frontage
/ / ,,Ye-z/ /6'3
7 Set Back-Front ` (L)S-1 (R)S-2 Rear Census Tract Module No. Initial
/30 1/.? oZ O I
>W ,
* 16 Architect Firm Name Street Address *
Zip City State Phone
( 1
Contact Person Phone if different than above
( )
rlf�ctor Firm Name Street Address'/ j
• �/c&eY
Zip 9g�d g Gty� I StaSe Q- Phone 7 i ^ �_ 7
[�.1;- personiff i Licensee No. / Phone if different than above
8 Owne .gent(if different than 01 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work Bldg ❑ MH ❑ New ❑ Replace ❑ Other
0 Fire ❑ Demo ❑ Add/Alter 0 Move
14 oO�esa Work a /r-
�'i rfGPJ
10 Applicant Name
Street Address
11 Zip City State Phone
( 1
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
r
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
❑ Fast Track !
❑ Early Start Release
Release /cond 1 Hold 2
T0 Environmental Health ❑ Commercial; ❑ Residential
W.1101 College (�)
9 ❑ New Construction; ❑ Bldg alteration/addition 12-047
Room 200 ❑ Additional structure; �/
APPLICATION� #
PP
Conditions/Comments: /LG' ./L6Ct Vd i Atip , . 6-- r `.
6 COY-/ ry A-1-... o-e7A.*---.-
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage;
N.721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; 0 fence;
❑ Other
Conditions/Comments:
0 Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain; I
N.811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
D Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
O Plan Exam
Fire Prey.
Conditions/Comments:
O.
co
c
i° Project Representative Telephone
0. Agencies Performing Special Inspection:
co
c 1.
Q O_
O .-i
~ 2.
y O
0
uC
_
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
ADDRESS: PROJECT N: 14'76
/ j
General - Yes No N/A
p'Uwnership Health
❑ Applicant Increased Lot Coverage? „
❑ Contractor Addition Bedrooms/
Fixtures?
❑ Architect Change of Use?
�/ New Septic? ✓
LAddr/ress -
��
�1eegal Description Plannin,
LYParcel Number Unplatted Property? i✓ -
Lot Depth: Width > 3: 1?
(Less than 10 acres)
Lot Depth: Width > 4:1?
./ (10 acres plus)
E [mo�oning Lot Size Less than Minimum?
Q'Site Plan Segregation of Platted
Property ?
❑ Plat Map Setbacks Less than Required?
ermit Description - Frontage less than Required? _
❑ Plans Not a Permitted Use in Zone?
Et Completeness Rezone, Conditional Use,
Variance Involved or Required?
La'Square Footage Commercial Use or Home
Occupation?
E'ccupancy Group & Type More than One Residence?
0 Departmental Releases Adjacent to a Required
and Conditions - Shoreline?
EnsIneerin.
New Access/Approach? —
Private or Unmaintained
County- Road?
Sepa
Underground Tank Over
10,000 Gallons
Commercial Building Over
12,000 Square Feet?
Over 20 Dwelling Units?
Over 40 Parking Spaces?
Agricultural Building Over
20,000 Square Feet?
Landfill or Excavation Over
500 Cubic Yards?
Critical Material
Designated as a Critical
Use Activity?
REVIEWED BY:. 9-1gal 9-1gDATE : Og/f-e3/P-5
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