HomeMy WebLinkAbout1984, 08-29 Permit App: 00002013 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)
Dep
(last) (first) (m)artment Use Only 20/ 3
1 Owner's a
..Comm
1--r, e € Oar I 1
2 Project Address (not Mailing Address)R d Name Space Zip
12-6ell6/leyw6u �l I
3 City/Community
Stat
Subdiv n/Plat Name
( i) OP i -1,/n I hi /
4 Assessor Parcel No.
/625H�
� ���� --02_5"
Lot
Block
* * * DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act. #
Zone �J Project No.
6 Dwell #
No. of Buildings
--
Sq. Ft./Acre
Depth
Af323
Frontage
/3e
7 Set Back -Front (L)S-1
(R)5 !Rear
Census Tract
1 Module No.
Initials Jf{/1}
16 Architect Firm Name
Street Address /
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
MC/ /6mi / (2enJr'
Street Address
PO /3y.2 / 6
Zip i
��o � �
City
li%- k�
State
(.amu
Phone
(Se 9) 2t; - 4464
Cont Person
k6n Me Dote' /<1
License No.
M''f Air C; `' Cc,1
Phone if different than above
501) 22-6— 3''6
8 Owner/Agent (if different than #1 above)
r;; 7r '<
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
'
Other (Y/N)
I SEPA Exempt (Y/N)
Date
15 Type Work Idg
0 Fire
❑ MH
0 Demo
4 1 Aew
0 Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
X 3ei def eee h e c/ rl9 e Qee 11
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 nota 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;
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
R/3u5�
Release
Release
w/cond 1 Hold 2
' E `I
Conditions/Comments:
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;
N. 811 Jefferson ❑ drainage ❑ new access/approach;
❑ road improvements
Conditions/Comments.
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions /Comments •
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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