1985, 03-15 Permit App: 00004499 Garage BUILDING 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)
y CP&Res Name (last) (first) (m) I Department U�eOnly
�. ✓ Comm
2 Project ress(not Mailing dd ess)or Road Name Space Zip
/�30 % / 0...e..— ?9 J 7
3 City/ mmunity State Subdivision/Plat Name �?
.to,614, ,,;_„ ,
4 Assessor Parcel No. Lot Block
01Z 33-4
_ 7 t 1) / / .2..... * * * DEPARTMENT USE ONLY * * *
5 Sic Code f 7' Zone Act.t.# Zone �� Project No.
V-1,-/9
6 Dwell R No.of BuildingsSq.Ft./Acre Depth Frontage
1 2 _ /V-7 Fe
N 7 Set Back-Front I(L)S-1 (R)S-2 •I l Rear i Cansus Tract Module No. Initials
1
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone if different than above
( )
8 ch:grr//Agent(if different than k1 IxAey, � n Bu nesA'd/dress y�
9 Zip , City State Phone
9 a ) 9 `.D.R L0iq ( > ,25"s-'.... 9
12 Review Required Plan ec (YIN) Other(Y/N) I SEPA Exempt(Y/N) Date
15 Type Work IS` ❑ MH 'New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
C40(-7hed C44Rf1cE'. 51/p 9
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
.
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.) i•
Fast Track
Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential . "S\.,
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional stru re;
APPLICATION#
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey. 9
Conditions/Comments: C/
a
Project Representative Telephone
U
cn Agencies Performing Special Inspection:
O c 1.
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►`- 2
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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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