1985, 05-14 Permit App: 00005406 Relocate GarageBUILDING 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 (lest) (first) (m)
!Departmentl;a0nly
Illnp`Aadr Road Names Spee zippc�/�
2 Prefect706 97:
S Otr5721 X/1NCr'L
State,{
45 //
SUMIVIymIpIa
(W/li^^W�
NamaL m Mph -
a
4 Assessor Parcel No.
2453N -03/F
Lots/ /��J
2LH2
Block
3
w w A DEPARTMENT USE ONLY * t *
5 soca
Zone Acl.i
Zone Ac sue
Project No.
B Swell 1
No. of Buildings
3
Sp. Ft./Aare
Depth
'*2
FrontageI
£5
Set Beek -Front
(OSA
w)S�
Rear
Census Tract
Modula No.
1110111
15 Architect Firm Name IStreet Address
Zip
Oty
State
Phone
( )
Contact Peron
Phone If different than above
1 1
Cantrmtor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Peron
License No.
Phone If different pan above
( )
8 Owner/ Of different than 41 above)
Busl eee Address
y/Agent
9 ZIP l /
City
�` �{�. (`
r/ ^`T1 1G'
State U/�
Phone 17_,2,5)_,...2g r-
12 Review Required
Plan Check rylN)
ober (Y N)
SEPA Exempt (V/ N)
Date
15 Type Work 6'3Idg
0 Fire
0 MH
0 Demo
G"..New
❑ Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
2X22 Ge-'AC4ed C=ARAae — move- on/
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
ZIP
City
State
Phone
I )
Contact Peresn
Phone If different than above
( )
Additional Intormatlon
6Rn44t is fl* -14W1 LOC frr
- ISS2I .APPuewPr(
4.049
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
Environmental Health
W.1101 Collage
Room 200
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required In either 'release' or "release with conditions"
space prior to permit Issuance.)
❑ Commercial;
O New Construction;
O Additional structure;
APPLICATION#
❑ Residential
O Bldg alteration/addition
Rel_^-:
Release
w/cond 1
Hold2
J.
Conditions/ Comments:
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson EN Seilbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments;
Engineers: 0 Commercial; 0 Residential; ❑ Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road Improvements
Conditions / Comments•
Utilities:
N.811 Jefferson
Conditions/Comments-
Other:
onditions/Comments-
Other:
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
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