1985, 04-08 Permit App: 00004814 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 Opt), (m) Department llyb Only
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2 Project Address(not Mailing Ad A Road N Sn� tom, // b r Space Zip( `9'
9444,
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3 City/Community State Subdivisio lat me �1_
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4 Assessor
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l No./ Lot Block
3"5 (cI— 67®2 2. ,, 9— * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.S Zone �/119—V a 6 Project No. 61
6 Dwell 0 No.of Buildings Sq.Ft./Acre Depth Frontage
f '7 /56
\ 7 Set Back-Front I(L)S-1 (R)S-24 I Rear Census Tract Module No. Initials
/ 7' f (/� i
* 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 01 above) Business Address
9 Zip City State Phone
) CoZ 3 e
6 �''V 1
12 Review Required Plan Check(YIN) Other(Y/N) I SEPA Exempt(YIN) Date
15 Type Work Bldg ❑ MH B' New ❑ Replace ❑ Other
❑ Fire ❑ Demo E Add/Alter a Move
14 DescribenWork�
/ 2 0
t" 57Or&a-e, fide
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
Environmental Health ❑ Commercial; ❑ Residential r --
j ,►
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition MIAMI
Room 200 ❑ Additional s ucture; `'" J
APPLICATION# � 7-3 2
Conditions/Comments: t
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; 0 fence;
❑ road improvements
Conditions/Comments:
Utilities:
--
N..811 Jefferson
Conditions/Comments:
Other: -_-
Plan Exam mai
Fire Prey.
Conditions/Comments:
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• Project Representative Telephone
a'' Agencies Performing Special Inspection:
Y o 1•
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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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