1985, 06-25 Permit App: 00006101 Storage I
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) Department ,•nly
Fl3s• Comm
2 Project Address(not Mailing Address)a-Rame Space Zip
, 17n5- /V- W/iL /R i'd, 9 9<ve b
3 City/Community State Subdivision/Plat Name
0ppoOlt iv;y .-S'_poKom I 1MQ, E"erE Ar'nFt /S. �/Te*
4 9S4(
-5
No. Lot l Block
Ir ,t ,t
C /S-54(- 44-3 DEPARTMENT USE ONLY ,t ,t *
5 Sic Code Zone Act.MZone ( Project No. f(�J1
6 Dwell N No.of Buildings Sq.Ft./Acre Depth Frontage
1 -�— _ 32t ' 14---z_1
7 Set Back-Front I(L)S-1 (R)S-2 1 Rear Census Tract Module No. Initials
— j,-
* 16 Architect Firm Name Street Address *
.In4,, ', / 1c 2 1 NiL /'95SLLI4745 N-/72c 1-,`711E-
G 3 4 TZ
Zip 'City State Phone
L'cLbE,0' GC*, ( ) 4a---i,7-7r
Contact Person Phone if different than above
( )
Contractor Firm Name / Street Address
CCC)h (�,E'cc, _9 L • -F14 Tr .5- 15ex PJ 3 'j
Zip City State Phone
99e'&17 (;Ti`s 7 eh cJ um, ( ) 9.1,/-/,)-s•7
Contact Person License No. Phone If different than above
.�'CdL� eCC- lT CccK 0C 4( .1,99J 4.7 ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(Y/N) Date
15 Type Work/ p--Bldg ❑ MH Q- New ❑ Replace ❑ Other
ti
� clG C ❑ Fire ❑ Demo E Add/Alter ❑ Move
14 Describe WOrk
- /X6LF7 scR'c( ---
.
10 Applicant Name Street Address
11 Zip City State Phone
( )
* Lender Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
ptlditional 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 Jond 1 Hold 2
❑ ��
Environmental Health ❑ Commercial; ❑ Residential •
W.1101 College
CI Construction; C7 Bldg alteration/addition � �
Room 200 CI Additional st ct r A to
APPLICATION# r-ti
Conditions/Comments: 111
❑ 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 CI new access/approach; ❑ fence; I
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
ci.
r.
❑ Project Representative Telephone
o. Agencies Performing Special Inspection:
co
1.
Y O
O f0
H 2.
in O
u
c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
- .
I
/ /1/40;y1l/TV ...:2-.—s-/ __,Z. c2, 1 ,-,2 _TT?A' irq. 4 ,r,-,) -2..c.,.- __ / 2 7
7iL,7 7
l./
?ry '14 ;1(7 / :( il/ _,c (// /
5: C)71z. -,- 'b .7 2474, 1 tit,..7/ --.7 P--4 r( 1/1/ 2--7
---
/ ,..., .
--- ?!
4. . - e TE
K --
r= . ,
•
A.
1 \ .
( b .
, .
A. . / •
i...,
C _i_7 7 4 vi-7-k -->
-.;,.
c:
,..-2/,, 7 ,A )2C:)
e_____
/.=//
-
-
(7s.
....,.....--.......-- . .. c-
>' •-.
• 'i '1‘'
'141 "Th ,7
V-- -1-•;
/7
..____
-- ---,
4---,- .7).t ----
(7 /V
....._
1 /