1984, 11-06 Permit App: 00003227 Garage• BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return thls original and your building plans to the Department of Building and Safety)
1 Owner's Name I (last) a (first) (m)
raparlmmtllYQ'Ily
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2 ROIeCtA/ (Ilot Mailing AtltlreG , Nap LS ,1 Space Zip 9pX p /7
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Assessor Parcel No.
4 a.5.5 -9v - 610 3 - 6e
Lot z
Be /�S
t 1 w DEPARTMENT USE ONLY w *
5 SIC Cade
Zone Act. a
Zone
IJfv,�1
Project No.
3227
6 DaeII Y
No. of Buildings
1
SQ. Ft./Acre
Depth
ore i6
Frontage
/o0
] SN BYk_F / I(L/0
(A)_e
R�
ONIauS Tract
Module No.
Initials
,B Archltnt Flrm Name I Street Address
DP
City ---
-State
Phone
f )
Contact Person
Phone 11 different then above
actor Firm Name ajo lay
Street
Address `�M
Ars*? E.
y
Zip 9q
/zd �
ityState
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/nA1� ai
V
Phone 9-22/. 0`al /
( ) / C
a� Person
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/ n,�K
OV
6 Own Agent Pf differnt thn x, Wove)
Bust
ess Address
9 Zip
City
State
Phone
(
12 Review Required
PI
n Check DON)
Oth 1((IN)
SEPA Exempt
(YlN)
Date
15 TYPtWork $Bldg
❑
Flre
❑ MH
❑ Demo
0 New
0 Add/ Aper
❑ Replace
0 Move
0 Other
14 ail"- 3 6 - `%266k-4-
.
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
OS
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
1
DEPARTMENT APPROVALS
This'is nota Permit
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit Issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments
❑ Commercial;
❑ New Construction;
A, Additional structure;c���/
APPLICATION a 6,44
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
)gym
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 let w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions / Com ments
0
Engineers: 0 Commercial; 0 Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage 0 newaccess/approach; 0 fence;
O road improvements
Conditions/Comments;
0
Utilities:
N.811 Jefferson
Conditions/Comments-
Other:
onditions/Comments-
Other:
Plan Exam
Fire Prev.
Gond ltlons / Cern ments
Project 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
t
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