1984, 06-20 Permit App: 00000749 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 Ow er's/Name �! (last) (first) (m) Department Use Only
Oh l C• v A (� rc-. SFk3sComm
Project Address(not Mailing C Address) Road Name d Space Zip
C y 9/h 6 7c;- /
3 City/Community . State Subyivisif n/P: Name
4 r Parcel No. Lot If Block
..6'. ,V ^ Po 6 `I / 61c i * ,t * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone -�) Project No. 74 1
6 Dwell# No.of Buildings 1 Sq./Ft./Acre Depth r Frontage
d 2-- I �✓
7 Set Back-Front 1 (L)5-1 (R)S-2 Rear Census Tract Module No. Initials
0 I
t' i I 2
-3K1Ot1 .
* 16 Architect Firm Name Street Address
Zip City 'State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address j 4
V
Zip City I State Phone
9 / r�t� .3 - 6-,2-2 ��
Contact Person � 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) I SEPA Exempt(YIN) Date
15n ype Work ❑ Bldg E MH ❑ Replace 0 Other
0 Fire 0 Demo 0 Add/Alter 0 Move
to-AL .K. -"..;&i .. .
14 Describe Work
10 plicant Named ` '' � // Street Address z. i
11 ip City State Phone
' 9 R:2/ :A2 -,14)6t- la-7-‹
* Lender 7 Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
r
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.) I•
❑ Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition 'm 1 '
Room 200 El 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:
❑ f 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:
c
❑ Project Representative
Telephone
a. Agencies Performing Special Inspection:
c 1.
O
O
�
I— E 2
O
O
LL
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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