SULLIVAN N 3808 OPEN STORAGE WHSE & LUMBER ~
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'BUILDING PERiN01T APPLICpT10Pl WORaCSHEET
V PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this original and your Dullding plans to the Deparlment of 8uildilig and Safety)
1 OMm6►'s NamO '(1091) (IIIHI) (rt►) OBWm6nt 118e Only .
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? Prqect Addreee, (not MailinB Addresa) cr qo,ad Name Space Zip
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3, Gty/Gbmmunilr 8tete Subdivisron/Plat Nnme
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~ OEPARTMENT USE ONI:Y s• e
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5 S!c Gbdel Lone Act ~•I Zc~e Pro►ect No.
g QmW1 0 No. oi BullOfnQB $Q. Ft.fAare DeOth Frontage
7 Sat Badt•Front (L)8-1 (A)&2 Rear Oanaus T►ect Module No. In{tiels
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~ 18 ArchiteCf Flrrti Nsrne Slreet AQdress
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Owftd Pe amn r Phone If dllforent than abcve
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OiDntractor firtn Name Street Adaress
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Oontact Peraon - Uoeneo No. Phone If dirterent than anove
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8 Zlp' Cdty Stete Phone
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12 Revlew,ReQuireO ptanCheck (YIN) Otfier (YfN) SEPA'Exempt (Y/N) Date
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15 Type Work 81dp L' MH )i( New f i qeAlace ZD Other
CI ' Flre pemo n AddJAlter 0; Move
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10 Appticant Nema Streef Address
~ 11 Zip City Sletp Phone
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~ Lender Streel Asfdress *
Zip. Gty State Phone
Contecf Pefson Phone if dilfe►ent than above
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Addltfonal Intormelion I
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DEPARTOVIEN"r 'APPROVALS
.
- - Ttiis is nota Permit
Applicafiori,Type:
(Stande~-d untess (Indicated approvals requlred in eitner•'"retease"'or-"releaee.with conditlons"
otherwlse ind(cated), space prior,to permit issuence.)
Fast Track
Early Start Release~
, Release w/cond 1 Hold 2
0 ~ _ - - ' - -
Envltonmenta't,Heeith D Commerctal; I-J Residantiai
W:-1i01;Cotiege C New Construction; r 81dg alteration'ladditlon
Room 200, D Addlttonai atructure; .
APPLICATiON q
Condltlons/Cflmments: - - -
~ PlanniRg/Zoning: Pe-ICcmmercial; O, Cert..of-Exemption; 0 Frontege;
N.721 Jeitersfln O Setbacks; CJ':lot'w/.d; O. I'oC'slte;: I]'-uselzone; .
O CU,_variance, zone,chenge; shorelfne; 0 tence;
C]. Other
Ccndltiona 1 Com ments:
~ Engineers: °mmerclal; C] Re`sldentfal;• ❑ Ftood Plaln; Z
N..811•JeNerson &'.drrainage Q new accessl,approach; 0 fence: ' 0 road:improvements, _
Conditlons/CoRnments: ~ , -
-Utltliles: N,-81;1 Jefterson-
.Caridttlons/Comments:
- - - ,
El Other: _
El Pian Exem , . ,
Fire Piev.
Condlflons/ Com ments:
ProJect Representetive. Telephone
~ Agenclea Performing'Speclal Inspectlon:
Y O
~
O Z.
U_, C
3: -
1 IRdkate above or-ettach conditlons reletlve to flnal-as buiit approvel
2 Indkete above or ettach reasone tor hold
.
~ ` 'ti;~-°':~;~ ;.P,', r DEPARTM EIVT 14PPROVALS: ~ ~i'' • This. is;not a. Permit- Applicat(on'Type
(Standerd unless (IndlcBted~approvals requlred in elther wrelease".or •release'wtth,condltlone' - ~
.otAerwlae-indicated) space.potortopermlt•issuance.) Fast Track
~ 'EeNy Starf Release
Release w/cond 1 Hotd"2
~ ' Envtronmentel, Health ❑ Commerctal; D Residentlal
W 116'1 Co11e9e Q New Canstructlon; C7 Bldg.elterationladdltion
Roam 2~' p Additlonal structure; ~
AFPLICATlON 0, Conditlons/'Cflmments: ~
- _ ,
,
~ Planning/Zontng: Q/&mmercial; •D Cert, of Eirempfion; 0 Frontage;
- i
N. 721 Jefferson O Setbacks; 0 lot_w'J.d; Q lot slie; 0 uee/zone; '
C CU,varlance, ione change;,slioreline; O tence; ~
u Other -
Conditio`nslComments: - -
/ ~ . - - - - - ~ Englnee'r's: ~7 ~ -mmecciel; 'O Residenttal; Q -Flood Pialn;- ~
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N. 811 Jeffetson J drainage O new-accessl,appraach; O fence; -
'Cl road'Impcvvements
ConditEons ! Com men ts:
- - ~
- - - ,
- - - , -
0 Utiltties:
N. 811 J,efferson' - , ~
Conditions'/Comments:~ - - -
- - - - _ ,
~ Other: _
i
El, Plan: Exam,
Flee Ptev.
~Conditions/,Comments: -
- - ~
ch • - -
C
t°P Project Representative Tefephone -
CL: AgenciesPerlorming Specfal,lnspectfon:
Y O -
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t Indtcate'ebove.or eltect►'condlNona-relettve to tinel'as bullt approvei
2 IndEcete obove or ettach reesons tor,hold !