1985, 03-18 Permit App: 00004514 Storage BldgBUILDING PERMIT APPLICATION WORKSHEET 5-2f
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 fi(last) (first) (m)
I
'l4!! ��Fl t)
OA
Department Use Only
Res. Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
5i7 !491LZjyu'A* %9'21.2-
3 City/Community
Dr S Fjrtrf,l nl
State
W/4,
SupdivlsionlPlat Name
iv St �,ti
d 7/Q.,�, lit,
4 Assessor Parcel No.
O .s4' /`v6 -2 F
/e3 -4/v-06
Lot
7 fi g
Block
Q
O
* * * DEPARTMENT USE ONLY it* *
5 Sic Code
Zone Act. #
Zone u 1
Project No.
6 Dwell ft
l
No. of Buildings
2
Sq. Ft./Acre
Depth
310
Frontage
92 1
7 Set Back-Fron
!'3s � rr'
(L S-1
'-k'
(R)S-2 f (Rear
5 I
Census Tract
Module No.
--
Initi Is
.1Uri 61 .
16 Architect Firm Name1/A
N
I Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
d0G'� ,up!'as `
Address
SZAddress
l3 es3B
Zip
9 9&,7
City
OriS u,ec/,,Areas
State
am
Phone
(.SZ ) 9.24— i.6 s7
Contact Person
Tor//v
License No.
et; o/<16* .229;T4
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 ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
❑ Add/Alter
_ Replace
7 Move
L✓Othe i
1
9
14 Describe Work /
e 6 /
To/ '
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
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
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
!v'
ConditionslComments
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:
Information
Plan Exam
Fire Prev.
ConditionslComments•
Project Representative Telephone
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
COOK BROTHERS CONTRACTING
Route 2 Box 853 B
OTIS ORCHARDS, WA 99027
(509) 924-1557
Ick RAS 117E r 9 - 8a2 a .
SHEET NO. F- 8S��J F '' // Y41
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DATE
CHECKED BY DATE
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FORM 204 Available from l E'BSf INC Townsend, Masa 01470