1984, 09-18 Permit App: 00002343 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) st) (m) rpartment Use Only
.�C h//ow/L 29-+G/0 - w. s. ✓ mm
2 Protect Address(not Mailing Address)cr Road Name Space Zip
.e• 6 7o z- s< r ,I U r ff.2 'A----
3 City/Community State Subdivision/Plat Name
01r/5411,c_ CA' Eur P,-PP
4 Assessor Parcel No. Lot _ Block
r (�3 y'f ^ l q O c t,J * * * DEPARTMENT USE ONLY * * *
5 SIc Code i Zone Act.Y Zone Project No.
6 Dwell k No.of Buildings Sq.Ft./Acre Depth t Frontage
1 2 10 0 L7
7 Set Back-Front I(L)S-1 (R)S-2 Rear Census Tract I Module No. Initials
1iaM
E>01-POG 15l t ,t
*
* 16 Architect Firm Name 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#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) I SEPA Exempt(YIN) Date
/
15 Type Work E Bldg ❑ MH 41New E Replace ❑ Other
ElFire ❑ Demo Add/Alter E Move
14 Describe Work
10 Applicant Na c Street Address
Z/ff
11 Zip Cit Sta/tem J Phone /
fly Z/ o}�isvti/E G/C /�` ( 3-� S.� Z LoJ�
* *
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.)
❑ Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
d Environmental Health ❑ Commercial;
❑ Residential /
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition tri
�Qom_200, Additional structure;
d
APPLICATION# /7trIs" r o
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.
Conditions/Comments:
ri
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Project Representative
Telephone
cn Agencies Performing Special Inspection:
O c 1.
H E 2
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u_
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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