1984, 06-06 Permit App: 00000549 Garage 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 (I t) (first) (m) I Department Use Only
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n38. Comm
2 Project Address(not Mailing Address)or Road Name y Space Zip
/I /l O-c/ 1. N--rein .ir>,
3 GtylCommuni State Subdivl /Plat me ..... Ext
rim.e /462--- ,/. e
4 Assessor Parcel Lot Block
(-50 _6-41/
` )9 O G9' ....3 , * ,t DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. LIfot
6 Dwell N No.of Buildings Sq.Ft./Acre Depth • Frontage
7 Set Back-Front I(L)S-1 (R)S-2 . I Rear Census Tract Module No. als_
* 16 Architect Firm Name I Street Address *
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Con tor Firm Name Str dress
Z( -� �d4 td, --jet..e --E.,.0t �'' /moo 7 _p y9" State Phon`ee
71.8ezZact/PersoC2 //iL
Li se No.
0,—
Phone if diff t 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) 1SEPA Exempt(YIN) Date
15 TypeWork Bldg ❑ MH >C1.._New ❑ Replace ❑ Other
Il Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe
cr) 7hal. (1X .o - t e.
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
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.) i
❑ Fast Track
❑ arly Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; tErile-sidential A
W.1101 College ❑ Now Construction; ❑ Bldg alteration/addition i 6
Room 2007M0'-Additional structure;;
APPLICATION# q� I��
Conditions/Comments:
D Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
LI CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
D I Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
. N.811 Jefferson ❑ drainage ❑ new access/approach; Elfence; I
LI road improvements
Conditions/Comments:
LI Utilities: 1
N.811 Jefferson
Conditions/Comments:
ii
Other:
0 Plan Exam
Fire Prey.
Conditions/Comments:
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❑ Project Representative Telephone
ca Agencies Performing Special Inspection:
CS
1.
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1- E 2
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3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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Each Small Square Equals 3 Inches
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I 4‘> Diamond Industries
x PLANNING SHEET
SPACE
FOR 7 l /y
UNITS REQUIRED
ADDRESS c... /,/ ‘,_--, ---Ya/V/Sua)/t/ •
DATE
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