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1985, 03-18 Permit App: 00004515 Storage Bldg - 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) I Department Use Only Z?) -21'', -21'. 4 .9 ale!5 Fes. Comm 2 Project Address(not Mailing Address)or Road Name Space Zip I. /-2 g/0 4‘1&.2,447n, ,&' . ” /4, 3 City/Community State Subdivision/Plat Name GIJ,4 3-r vicx 1d" t, 4 Assessor Parcel No. Lot Block O 3 6-4/.2-0306 , 5— 4. 3 * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone �� Project No. --f5-1 6 Dwell# No.of Buildings Sq.Ft./Acre Depth (l Frontage I Z l8c1 55 ) 7 Set Back-Front I(L)S-1 (R)S-2 t f Rear t Census Tract I Module No. Initjals� 1 /�cP ;�' ��/rvVfr * 16 Architect Firm Name Street Address * cc Zip /� City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Strget Address �! Zip City 1 State Phone ?90.;-,z 7 f T/s 6,Qe/M,-O-5- a)n ($09) AV-- /S Contact Person License No. Phone if different than above 37)HA./ deo X de. *I..7. 9 J 6 ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(YIN) LSEPA Exempt(YIN) Date 15 Type Work 0 Bldg ❑ MH ;9( New ❑ Replace ( Others. t CI Fire ❑ Demo 17Add/Alter ❑ Move 14 Describe Work tc /E ,d//y,/ • . 2)`X D/ 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 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 ❑ Early Start Release Release w/cond 1 Hold 2 ❑ J Environmental Health ❑ Commercial; ❑ Residential / /✓� W.1101 College El New Construction; ❑ Bldg alteration/addition • 1 Room 200 El Additional structure; 3'if-v-) APPLICATION# 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; ❑ Flood Plain; N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: Other: • ❑ Plan Exam Fire Prey. Conditions/Comments: a c❑ Project Representative Telephone U Agencies Performing Special Inspection: c 1. . O '— N �p E 2. N O LL 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold • , k, • _. 7:2'e -_3-_-_-C,k1•2 COOK BROTHERS CONTRACTING -- , - Jr 0 ., - • I a, Route 2 Box 853 B . SHEET NO. : ... - OTIS ORCHARDS, WA 99027 ,. 4„. ,..,./.... CALCULATED BY..,210 A AICC.JA- /"P" DATE (509) 924-1557 4..... t CHECKED BY DATE • SCALE `..? .• a i i ; ; ; .• . 1 . . . : . • . • •• . . • : -kA.•4 il:L I i ; ''t i•• i: ."'f ' . . .1/11 1 .. .• : . . , 4 i .. . .. : . . • , . • • . ! 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