1984, 07-10 Permit App: 00001100 Storage t
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 r�/(last) Y► (first) (m) Department Use Only
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2 Project Address(not Mailing Address)or Rod Name Space Zip
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3 City/Community State Subdivision/Plat Name
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As
4 Parcel No. „2` 4,2_-;2 34.54 Lot Block
* * * DEPARTMENT USE ONLY * * *
5 2-- 3 7'-i W%e4 S 3
5 Sic Code ZoneAct.N Zone Project No.
- f/?.- 100
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
R t 0 /36 t
7 Set Back-Front I(L)S-1 (R)S-2 Rear Census Tract Module No. Initials
sl ! Cl I , JvN i'
* *
16 Architect Firm Name Street Address
.1" tiE
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Zip City State Phone
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Contact Person Phone If different than above
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Contractor Firm Name Street Address
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Zip City State Phone
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Contact
� jPerson License No. Phone if different than above
4 .—C)
—1 O? /7 Al e,,,r KC,ad Ec .2,2 9 J I ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) SEPA Exempt(YIN) Date
15 Type Work Ri` Bldg ❑ MH lit New E Replace ❑ Other
❑ Fire ❑ Demo 0 Add/Alter 0 Move
14 Describe Work ,/ / --3( ,,(
04'3` J�Dgg J /L'r�Aci ; �t.' am
(y
10 Applicant Name Street Address J
/ J'PrEcJ vVEy N f- l2 'iaa Z,--
y State Phone
11 ZipCit 1, ( ) 7� .
99'CQ n e?pr. [UN; I( ua� . 9
* 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; El Residential D
W.1101 College ❑ ew Construction; ❑ Bldg alteration/addition ,/ /
Room 200 Additional structure; /a
APPLICATION# /1/5?
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; 0 lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage El new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other: 1
❑ Plan Exam
Fire Prey.
Conditions/Comments:
c❑
°j Project Representative
Telephone
Agencies Performing Special Inspection:
Y o 1'
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�`— E 2.
m
ca c
u
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
- COOK BROTHERS CONTRACTING .,
•
' Route 2 Box 853 B SHEET NO. .. ..--ie, 'A7a2C i t="7 OF r.-'- : , ,7/,4 ' 17
OTIS ORCHARDS, WA 99027 /:2,'V '
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(509) 924-1557 CALCULATED BY :1"1/1 ',/ ,5 /
DATE
CHECKED BY DATE
SCALE
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FORM 204 Available from 7 EA.rinfc Townsend,Mass 01470