1985, 03-15 Permit App: 00004490 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) Department y�e Only
\
EI ki /J O5 Am M . IRes. 1/{
Comm
Rooaad NameI. /'� , ace `A Zip
2 Project Address (not Mailing Address) or Road(.-5.;
D. 2,023 �fAN�f�5 Ca . PO �1� W �? zo
3 City/ mmunity
D�CAN_
State
,
SubdiJision/Plat
C A
Name
s1 2 I--4; 115
Ado,
4 Asserisor Parcel No.
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code `
Zone Act.*
Zone A.
Project No.
�
6 Dwell MI
No. of Buildings
I
Sq. Ft./Acre
Dept
f?4'
Frontage
ill i
7 Set Back -Font
(L S-1
(R)S-2 i
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Conte Person
Phone if different than above
( )
oW — i` \, ,
Street Address
Zip
912o4,
City
.�okAi
P
State
WA.
Phone
( ) 9z6-(0? 1 3
Contact Person
License No.
Phone if different than above
( )
8 O�gr/Agent (if different than 41 above)
Business Address _p,
. 3So g es (it
g Zip
q920Z
City,__,State
pokit) Ili L
wP.
Phone
(509) 5 34,- 71077
12 Review Required
Plan Check (Y/N)
Other (Y/ N) 1SEPAExempt(Y/N)
Date
15 TypeWork ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
$ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
2.2/ . Z7 / CSPRAq1./R1_1(40SCIcxisf « �ARjE r i
10 plicant Name Street Address v
AkV �IkiN 50. 202-3 Sc-.Ni2:5£Plc.
11 Zip
192-61.
City
State
L OA.
Phone
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Info oration
t
0
c
(5
0
0.
co
Y
0
lC
it -
7) N
lC
LL
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application
This is not a Permit
❑
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 w/cond 1
Hold 2
Environmental Health ❑ Commercial;16
E Residential
W. 1101 College 9 R New Construction; ❑ Bldg alteration/addition
Room 200❑ Additional structure;
�
' /
3-�5—$�
APPLICATION # ,'10/ 3-3
Conditions/ Comments• 169.ee 1 , 12i ,
❑
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; D lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; D fence;
❑ Other
Conditions/Comments.
❑
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
0 road improvements
Conditions/Comments.
❑
Utilities:
N. 811 Jefferson
Conditions/Comments.
•
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative Telephone
Information
Agencies Performing Special Inspection:
1
2
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
z
1