1985, 11-18 Permit App: 00008771 Garage 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) I Department Use Only
cC .-n 6'S 0 y 1 -C...�- REG. Comm
2 Project Address(not ailing Address)or fbad Name Space Zip
. ( � ) 't ?� , l'} :art% c4LSZ-L.414-
3 City/Community State ; Subdivision/Pia Name 4
44
-`. ,C-a-A..../1-- t�0";'` CSS ( c
4 Assessorfrcel No. f Lot Block
; 7�1,, i1
) ' O l 3 ] * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone / ; f Project No. 6(1)
6 Dwell# , of Buildings Sq.Ft./Acre Depth I Frontage i
j 2 I4°gv
7 Set Bads-Front (L)S-1 1 (R)S-2 ) Rear , Census Tract Module No. Initials
•''1 -'I 1\16 �5 2 3
* 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
°1CI .zl -L r,, W --,
( ) 72 -- 3L,
ContactP?zioi, ( License No. Phone if different than above
c'7b,ti 1 _1 01--- ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( 1
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(Y/N) Date
15 Type Work Bldg D MH New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Workr ,r
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 I 1 j1
W.1101 College CI New Construction; ❑ Bldg alteration/addition / `, rN
Room 200 ❑ Additional structure;
APPLICATION# I
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;
N.811 Jefferson ❑ drainage ❑ new access/approach; El fence;
I
❑ 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
c 1.
Y O
'
�`- E 2
o
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
•
WOODRUFF Rn.
00 0
V
38'
41— 20* 2.-). EXISTING —*-
HOUSE
A 6. o.' _
1400 '
CESS POOL
54 0"
V
42'
do— 23 0- PROP 24'
GARAGE k 0" ob.
LOT 10, BLK 1, MISSION ADD.
-7