1985, 07-01 Permit App: 00006179 Deck BUILDING PERMIT APPLICATION WORKSN,EET
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 /�(llast)// / (first) (m) Department Use Only
I`t ilk(l {�aT r 7 '� Res. Comm
2 Project Address(not Mailing Address) Agad Name ` Space Zip�Q 37
/ ' o5 My/
/�hj— q
3 City/Commu ty State Subdivision/Plat Name
Ve-rat al �� `� ys C���,�fo�c
4 Assessor Parcel No. Lot Block
!; 3 5") 4 —4507 Lot 7 / * * * DEPARTMENT USE ONLY * * *
`S 5 Sic Code Zone Act.# Zone !� Project No. (0,
6 Dwell ft V No.of Buildings Sq.Ft./Acre Depth Fronta.e� 1
t _7 SeBack-Front �� I(L)S-1 (R)S-2 I Rear Census Tract Module No. Initials _
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( 1
Contractor Firm Name Street Address
Zip City State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone ) — 419& 5
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace ❑ Other
0 Fire ❑ Demo Add/Alter ❑ Move
14 Describe Work t 1
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 r •
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.)
Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential +4
tuX
W.1101 College El New Construction; ❑ Bldg alteration/addition
iii
Room 200 El Additional structure;
APPLI •TION# APIrC
i ! . 9 �p
Conditions/ omments: �<<- - _ ( ' v C7 v�' �— `' 4'gar
69j -4‘ ;g2 (26(6)4A
0 Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; El Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; El fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson El drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
iIt � �'
Fire Prey.
2
Conditions/Comments:
ri
°� Project Representative Telephone
o. Agencies Performing Special Inspection:
O c 1.
U
R
E 2
5 O
OC
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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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