1985, 05-15 Permit App: 00005433 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)
1 Owner's Name (last) (first) (m) I Department ly
fCI V1 V r eco r L{ Ras. Comm
2 Project Address(not Mailing AddreS Road Name ` Space Zip
t /09x7 / Clq�/
3 City/Community State 1 Subdivision/Plat Name
4 As�P Parcel No. e Lot ( @l A Block ak-cr/tt c/ I eeAdi
I
7 757 3 _ / Q 8 * * * DEPARTMENT USE ONLY * * *
—, 5 Sic Code 'f Zone Act.(M/��` Zone Project No. -
e s _; ,
6 Dwell ffDepth Frontage
No.of Buildings Sq.Ft./Acre
/ /'/ HiQ
7 Set Back-Front I(L)S-1 (R)S-2 !Rear
Census Tract I Module No. Initials
* *
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 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone q WC/
6 9
12 Review Required Plan Check(Y/N) Other(YIN) I SEPA Exempt(Y/N) Date
15 Type Work Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo Add/Alter ❑ Move
\ 14 Describe Work (0,19 ,YT` tG A I1ACh od (�`,y 4 f'4 —
10 Applicant Name r/ / ` Street Address
11 Zip City State ' Phone
( )
* Street Address
*
Lender
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.)
❑ Fast Trackr
❑ Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential ,14-
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition J'
Room 200 DI Additional structure; s`/S�
APPLICATION#
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
O 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.
Conditions/Comments:
a
rn
c❑
c6 Project Representative
o Telephone
aa. Agencies Performing Special Inspection:
Y O 1.
U --
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F- E 2.
as
V_ C
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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