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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 /Fe Pi"�LLd/l > /,/moi Fbs. Comm 2 Project Address(not Mailing Ad A Road N Sn� tom, // b r Space Zip( `9' 9444, 1 3 City/Community State Subdivisio lat me �1_ .�/jt �. t IA6ii Q A kre5 54k �c/ 4 Assessor 0,6:9/Y41-fit) 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: • c • Project Representative Telephone a'' Agencies Performing Special Inspection: Y o 1• 0 •0 E 2. 7) LL • C 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold 5 klikepitto /17/6"K 0e/(& 61-z6-349/ �, S ,( 13g) la /"u ,�/PC1 1lF-- No 's 111 a — -41 ,A . _."'____ i 111 ‘,4111 'T ttk ?I\ 1 ,,..r ,,,, , „ 4:‘ , .4) ri. . 1 1 • ql AV gi- 7' Et .0 - K.\ (It _ I , A i_. __ tt -a kg , • s wir ri, fiG „ * 9 ‘k ' t „ __. _ _ .r ., k,,,, 'N.,. H . w , (''t .,_4- '-^"4 Vfis ry li 0