1984, 04-18 Permit App: 84A-3485 ShedBUILDING 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' £.i3_ Oast) (IIM*) (m)
Depart Use Only
/' 0/4//1.F!( 1/2 g44€72,-,
Ra. Comm
2 Project AMErese (not Mailing�7 Address) cr Read Name Apace ZIP
tr/9a/ iseTss 917
3 Cly/CUmmuNy
s"/Ja,�r54c.
Stele
Subdivision/Plat Name
CDA6%e% e,-:
4 A95mor Parcel No. .
Lot
J £/
7
Block
P2
,,,,e,
* * * DEPARrMENTUSEONLY * * *
5 Sictbde.
r
.Zane ALY
L
Zone
Project No.
8 PMI N
No. of Bull Ings
Sg. Ft./Acre
Depth
Frontage
7 Set BaA-Front
FI
9.1S-1
(1)S-2
Rmr
Ozone Tract
Module No.
Initials
18 Architect FI m Name
Street Address
Zip
Oy
State
Phone
1 )
Contact Wrenn
Phone If different than above
( )
r Contractor Firm Name
.L/i3/%r/fO.d/ `/L//f2I/
Street
Address
Zip
l
CityState
5,6
I Guq.
Phone
( )
Contact Person
1 Li No.
Phone B different than tette
8 OwnerfAgent l0 different then el above)
Dual
ass Address
9 ZIP
COY 4 '
State
Phone
( )
12 Review Rayuired„
Plan
Deck (Y/N)
Other (YIN)
I SEPA
xempt (Y/N)
Date
15 Type Work m ---Bldg
0
Fire
❑ MH
0 Demo
ZY New
0 Add/Alter
❑ Replace
0 Move
❑ Other
14 DescribeWork
.3o x
3a' S//,tO
10 Applicant Name
C���
Street
Address
11 ZIp
City
State
Phone
1
Lender
/'27,,
"
Street Address
Zip
City
State
Phone
I
Contact Person
Phone if different than above
Additional Int ormatkan
0
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
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
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATION # D 4tu^ 6322-,
O Residential
❑ Bldg alteration/addition
Release
Release
w/coed 1
Hold 2
Conditions/Comments
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; ❑ Cert. of Exemption; 0 Frontage;
❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments:
0
Engineers:
N. 811 Jefferson
❑ Commercial; ❑ Residential; 0 Flood Plain;
❑ drainage 0 new access/approach; 0 fence;
❑ road Improvements
Conditions / Comments•
Utilities:
N. 811 Jefferson
Conditions/Comments ..
0
Other:
0
Plan Exam
Fire Prev.
Conditions/Comments:
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