1985, 03-28 Permit App: 00004699 Relocate Storage Bldg f' 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 Use Only
>/////e/? 0. 0 f CI . Fps. Comm
2 Project Address(not Mailing Address)or Road Name/ Space Zip
-- 1� 2 S , (-2) l b e-C r
3 City/Community State Subdivision/Plat Name �,��
6�b,f'dr ,/ ,k_. f/��Q S Z9i�e LCA —� .ClV�`-'
4 Assessor Parcel No..44 1 4 111 Lot (( Block 1� * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. P
6 Dwell# No.of Buildings Sq.Ft./Acre Depth ' Frontage
1
2 t si 40 ►
7 Set Back-Front (L)S-1 (R)S-2 Rear Census Tract Module No. Initi Is
C 5 � S S ' —1U N
* 16 Architect Firm Name Street Address *
Zip City 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) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(Y/N) 1 SEPA Exempt(Y/N) Date
15 Type Work yl. Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work S fbttA'G - 17/ nit) 6/6b
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
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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
twee w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential �
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition ''
Room 200 ❑ Additional structure; `° �S
APPLICATION#
Conditions/Comment ._1 /7 a► / • 46-"
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
O Other
Conditions/Comments:
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; I I
. N.811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
O road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey.
Conditions/Comments:
ci
c
❑ Project Representative Telephone
a Agencies Performing Special Inspection:
co
1.
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R
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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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ADDRESS: S , 30 0 V GoI 4Fson.i wi • PROJECT #:
General - Yes No N/A
Ownership Health
❑ Applicant Increased Lot Coverage?
❑ Contractor Addition Bedrooms/
Fixtures?
❑ Architect Change of Use?
New Septic?
0 Address -
❑ Legal Description Plannin.
Parcel Number Unplatted Property?
Lot Depth: Width > 3:1?
(Less than 10 acres)
Lot Depth: Width > 4:1?
(10 acres plus)
❑ Zoning Lot Size Less than Minimum?
O Site Plan Segregation of Platted
Property?
❑ Plat Map Setbacks Less than Required?
❑ Permit Description - Frontage less than Required?
O Plans Not a Permitted Use in Zone?
❑ Completeness Rezone, Conditional Use,
Variance Involved or Required?
❑ Square Footage Commercial Use or Home
Occupation?
❑ Occupancy Group & Type More than One Residence?
❑ Departmental Releases Adjacent to a Requi red
and Conditions - Shoreline?
— — —
End neerin•
New Access/Approach?
— — —
Private or Unmaintained
County-Road?
Se.a
Underground Tank Over
10,000 Gallons
Commercial Building Over
12,000 Square Feet?
— — —
Over 20 Dwelling Units?
— — —
Over 40 Parking Spaces?
— — —
Agricultural Building Over
20,000 Square Feet?
— — —
Landfill or Excavation Over
500 Cubic Yards?
Critical Material
Designated as a Critical
Use Activity?
REVIEWED BY:. DATE :