1985, 07-08 Permit App: 00006265 Garage+
r 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)
(last) (first) (m) Department U Only
1 Owners Name
:Tal n .4 FBS.
I
t T
Comm
(J�e"kbo>
2 Project Address (not Mailing Address) a Road Name Space Zip
E /(7si9 c.4. A I
3 qty/Community
State
Subdivision/
Plat Name `p(1t/1�As sow.
4 Assessor Parcel No.
70�� - f
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 SIC Code
(2-
Zone Act. #
Zone 064S06
Project No.
6 Dwell #
1.
No. of Buildings
Sq. Ft./Acre
Depth) 3p I
Frontage el
I Set Beds -Front
�Ctsrl NG
(L)S7(R)S�
—
t
_-JIV Rear
Census Tract
Module No.
als
Inttl'1� � •
.
16 Architect Firm Name
I Street Address
Zip
Clty
State
Phone
I )
Contact Person
Phone If different than above
Contractor Firm Name
�d?fi� ��(Clty
la/UST
Street
Address
P,_ Bo 7 7 C
Zip
9 9aa 7 —ofa y
SPO°Cei P
State
ci,9—
Phone
( ) 5'83 -- S2f
Contact Person
S0Iwt' z N
Licen No.
Be -sr- we - o18&' j
Phone If different than above
( )
8 Owner/Agent (if different than 41 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (Y/N) I SEPA
Exempt(Y/N)
Date
15 Type Work 0 Bldg
0 MH
AC New
0 Replace
0 Other
0 Fire
0 Demo
0 Add/Alter
0 Move
14 Describe Work nVvmi l910J 1G9`a1- O P n•2-0`/(9--e-J
/ l
p
_ „'O G
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
Application
This is not a Permit
Type
(Standard unless
otherwise Indicated)
• Fast Track
-
(Indicated approvals required in either "release" or "release with conditions" n
space prior to permit Issuance.)
❑ Early Start
"
Release
Release w/cond 1
Hold 2
1
Environmental Health ❑ Commercial;
W. 1101 College 0 Residential ,ew,
Room 200 0 Additionall struicture; on; Bldg alteration laddltladdltlAl
APPLICATION # /9 d O?O
Conditions/Comments.
•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone•
0 CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Comments •
❑
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments.
•
Utilities:
N.. 811 Jefferson
Conditions /Comments •
•
Other:
---
Plan Exam
Fire Prev.
Waal
Ili
Conditions/Commentsit
Information C
Protect Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
5'4 S 7.
Gee
PEA f) N c e-