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1984, 10-25 Permit App: 00002951 ResidenceBUILDING 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) (fast) 1 Owner's NameDepartment Only (first) (m) ,4 7://)//1 -Al /PPA/19T f Ras. //N Comm 2 Project Address (not Mailing Address) or Road Name Space Zip X114 77- 3 City/Community ...17- 0 /r-41 iv?, State r.--1../././ N Subdivision/ Platame 3/ L' SP- p_FL, - 4 Assessor Parcel No.ep-rry (y ..3-(310 } Lot 'Block * ,t ,t DEPARTMENT USE ONLY 255 1 CLOM- �{ Y�T , ) 5 Sic Code Zone Act. if / Zone AGS,, Project No. 2 5`/ 6 Dwell N / No. of Buildings / Sq. Ft./Acre IA Depth L25 Frontage 150' 7 Set Bads -Front (L)S-1 (R)S-2 Rear Census Tract Module No. F5* 16 Architect Firm Name I Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address Zip City State Phone ( ) Contact Person License No. Phone If different than above ( ) 8 Owner/Agent (if different than 91 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan CtIck vvjj Other IN) ESEPA Exempt (Y/N) VC, --' Date 15 Type Work ly Bldg 0 Fire C MH 0 Demo trNew C Add/Alter C Replace 0 Move ❑ Other 14 Describe Work ��` lieSr C%eb. 0 l 7,6 j� &C�7 te`1 C�/ 10 - O11/1i19/cam (7--- I.// trd.-ti Street Address 7-10 3 N war�474- 11 Zip 79,Z/ 7 City -- 11-o State z� Phone ( 1 /2/9/J _ V'sy 7333 Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information /7 q7 MF 0338 izcio uri 3S1/ all, 7 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 condition" space prior to permit issuance.) Environmental Health W. 1101 College Room 200 ❑ �Commerclal; 'Residential New Construction; 0 Bldg alteration/addition ❑ Additional structure; APPLICATION N gal- ia.SS •\ e, Release Release w/cond 1 Hold 2 0 6 ®/" of - Conditions/Comments' -4 &&. ,LQ/-1-/.di7 ree: 1$40,—e17/ -‘12—e LI Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage; N.721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone' ❑, CU, variance, zone chane; shoreline; 0 fegce; / Other SkkOR t ¶t4 tt Conditions/ C a ts' Sit- 69- 310 t Fd' i01 i.�I� 0 Engineers: 0 Commercial; 0 Residential; 0 Flood Plain N. 811 Jefferson ❑ drainage ❑,qew access/approach; ❑ fence, 0 road improvements Conditions/Cr ` ezzAt • Utilities: N. 811 Jefferson Conditions/Comments' Other: Plan Exam Fire Prev. /O//el/A /1:(Ma Conditions /Comments' Project Representative Telephone Agencies Performing Special Inspection: 1 2. 3 1 Indicate above or attach condition relative to Ilnal as built approval 2 Indkate above or attach reasons for hold z, a 1b, j l N ; W 6' O 4Q A' �a�E+�'c^�'n-. •-'fit'+-r'.r'f'+��' y ,smsg "rte` ms .• '7`•71701".::Mist V_ES\�@.�^E •74 • ir