1985, 06-14 Permit App: 00005993 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 -1- ,...per's Name last)/ (first) Department Only
, 7 `j = !/,1, .AJ A_A.,e c f REG. Comm
2 Project Address(not Mailing Address)or Road Na Spaceip
3 City/ nity StateSubdivision/Plat Name
4 r Parcel No. Lot Block I
* DEPARTMENT USE ONLY * +
6(A
3 - D( 2-v
5 Sic Code Zone Act.# Zone Project No.
6 Dwell* i No.of Buildings Sq.Ft./Acre Depth i Frontage
l 2- (2/e, q(0
7 Set Back-Front II(L)S-1 (R)S-2 Rear Census Tract TModule No. Initials
�fit'1 N6 I JuN iM ,
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( ) 9? —0 'P.
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH D New E Replace 0 Other
0 Fire 0 Demo ❑ Add/Alter 0 Move
14 Describe Work '
10 E- 1i/LDG - 12 >C20
10 Applicant Name Street Address
11 Zip City State Phone
( )
* Lender Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Y
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.) r
Fast Track
Early Start Release
Release w/cond 1 Hold 2
2.11 Environmental Health ❑ Commercial; ❑ Residential �Q,,,,/) •
W.1101 College El New Construction; EI Bldg alteration/addition `;
Room 200 A. Additional structure;
APPLICATION# 3 O 1
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; I
. N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
O Plan Exam
Fire Prey.
Conditions/Comments:
a
°❑ Project Representative Telephone
Agencies Performing Special Inspection:
O• c 1.
U —R
E 2.
y O
O
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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