1985, 06-05 Permit App: 00005751 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) (first) (m) I Department Use Only
_5-4 G:/7 L�,l2/'J,'Nc Res. Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
67o8 E 5.r- z 1-1.''
3 City/Community State Subdivision/Plat Name
4 Assessor Parcel No. Lot L jL, k„..,Z4...5-3 l 2 003 7 IBA,,/fe
* * * DEPARTMENT USE ONLY *
5 Sic Code Zone Act.# Zone �� Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage 1
t) I 13V
7 Set Back-Front II(L)S-1 (R)S-2 'Rear }
Census Tract Module No. Initials
-?�) I i I 10 rf JUN V11 .
* *
16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
"9/0 Lo- S r= c-,L. 3�,r L y zii 7 G- .,..63o,--71,,,c4-,e----
Zip City 1 State Phone
-s l<",,,,,,, Et/ 14- ( ) 9 $'(—15eb
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) •
Business Address
I
g Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) I SEPA Exempt(Y/N) Date
15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire 0 Demo 0 Add/Alter ❑ Move
14 Describe Work
5.1-0 if456 . .10(,1 • 6v0 r...J`O 0)
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 1
` M
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.)
0 Fast Track
Early Start , Release
Release I w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION#
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; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey.
Conditions/Comments:
a
c
c❑
Project Representative
Telephone
ca Agencies Performing Special Inspection:
1.
0
U '-
co 1,1
E 2.
roo
u_
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
,tULES: HOMEOWNER:
1) Building must be 5'from property line
2) Building must be 10'from drain field ADDRESS: 7/2. 4:::7i957' 2 4149
3) Building must be 25'from property line
it property line is next to a street PARCEL No. 29 3/ — 2 Go
4) Building must be 10' from all existing bldgs. LEGAL: /47/ jam, , dA•J �- 4.`
, Loc g241
03
d
36
0 ?°r411/ 1I
i r
I. Draw in all existing buildings.
2. Draw in new building& how many feet it is from existing buildings and property lines.
3. Name all roads next to property.
4. Draw in drain field and whether you are on a septic tank or sewage system.