1984, 06-13 Permit App: 00000676 Garage t. 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 (last) (first) (m) cepa t Only
• Comm
2 Project Address(not ailing Addr cr Road Name Sp�� Ras. Zip
T/6-701/ —ty 44.1
3 City/
mmunity� State Subdivision/Plat Name
/ /1/.;6 (2-14r
4 Assessor Parcel No. Lot Block
.135 4.3 t 1 i {q/ . . . DEPARTMENT USE ONLY * * *
,/ 5 Sic Code Zone Act.# I Zone kes
R t Project No. /
(( 6 Dwell# No.of Buildings Sq.Ft./Acre pth' Frontage
7 7 Set Back-Front (L)S-1 (R)S-2 l Rear Census Tract Module No.
* I *
16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm Name Street Address
Zip City State Phone
( )
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than 01 above) Business Address
9 Zip City State Phone
( 1
12 Review Required Plan Check I ) Other /N)
1SEPA Exempt(Y/N) Date
15 Type Work t Bldg ❑ MH - /New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work _Ac{ier) 6,44 /
10 Applicant Name j2 , Street Address
_ f-4,3---7: -/ i�, % �12.e/
11 Zip �� City State Phone
�9C 7 r � P Ill (9 ) �a�f7
* ' *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
• I ( )
Additional Information 4C i'Cr'
COS`e'O ,{ )-7(
. f V
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.)
❑ ast Track
01 Early Start
1 Release
Release w/cond 1 Hold 2
Environmental Health ❑ C mmercial; Residential
W.1101 College ❑ ew Construction; ❑ Bldg alteration/addition 611_5(.571
Room 200 Additional structure;
APPLICATION#
Conditions/Comments:
D 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:
O Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
. N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
El Utilities:
N.811 Jefferson
Conditions/Comments:
El Other:
^
O Plan Exam
Fire Prey.
Conditions/Comments:
a
❑
•° Project Representative Telephone
ca Agencies Performing Special Inspection:
Y g 1.
O
U -2 N
F- 2.
1 O
RS C
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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