1985, 05-14 Permit App: 00005403 Shed 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) Departmen
A/Er/47 / t ly
2 Project Address(not Mailing dress �U AlS7A�T L' fes. !Comm
a Road Name Space
C ' ..? /.2 A/ l/if.4 rx4c-dQ Zip
3 City/Community State ��'���
S10–/-Parcel
t ' ' Subdivision/Plat Name �1
4 AsseejssoorPaaarcel No. w� �' L � S �p 'r
2 15 1 3 ✓ Z�QD 1 Lot l I Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.N Zone
Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre 5Ve,
2 pth ) Frontage
11 TDepth
gE3 I
7 Set Back-Front I(L)S-1 i Rear Census Tract��A` IS
Module No. Initials
rel 7 t(R)S-2
�— � // I
* b
16 Architect Firm Name
-Rik} m
IStreet Address
Zip I City I 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#1 above) ( )
I Business Address
9 Zip I City
I State I Phone q
(5-0 ) 9..V- 3"3`,S 0 .
12 Review Required 1
Plan Check(Y/N) Other(Y/N) I SEPA Exempt(YIN)
Date
15 Type Work V, Bldg ❑ MH
X New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter D Move
14 Describe Work --
« x Z s (6)PEN 'I Side
T)Applicant Name
Street Address
11 Zip
I City
I State I Phone
*
Lender
*
Street Address '
Zip I City
I 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.)
❑ Fast Track Release
❑ Early Start Release w/cond 1 Hold 2
tg r Environmental Health ❑ Commercial; ❑ Residential ``
W. 9
1101 College ❑ New Construction; ❑ Bldg alteration/addition � _
Room 200 El Additional structure;
APPLICATION# A- 1 a<
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; I J I
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; I I I
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities: I I I I
N.811 Jefferson
Conditions/Comments:
L
I I
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
ci.
m❑
Project Representative Telephone
n Agencies Performing Special Inspection:
-
Y c
O 1.
O '—
T to
N t 2
y O
O C
u
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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