1984, 05-22 Permit App: 00000310 Garage •
r
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 --R7 (last) (first) (m) Department UoeOnly L e h G l'1 Ras. i/ Comm
2 Project Address(not Mailing Address)or Road NameSpace Zip
L . /s c4' /8`"� 9`%a /6
3 City/Community State Subdivision/Plat Name
;icoA.; e- U0 tte.1 CJS
4 AsJ Parcel No. Lot I Block
2 /r T-1 2 —9
O 4 0 * * * DEPARTMENT USE ONLY * * *
X5 Sic CodeZone Act.# Zone Project No.
\ 6 Dwell M No.of Buildings t Sq.Ft./Acre Depth i Frontage I
/` I to j (0
7 Set Bads-Front (L)S-11 -2 Rear Census Tract Module No. Initials
l , S ' Jo 1.3 M •
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Contractor F rm Name Street Address M
Rsh et— C-(--= Sir LiA it 4/1 �- /J 7 /d MA r n
Zip City State Phone
9 -1!F pc-)Kc e. (Jc, . ( ) 9(29'• D3 f
Contact Person License No. Phoneif different than above
d
Sfeue il: he( ,3.3 -GI /46.-e )6,'R(- ( ) 9,7:)q .-f9a31
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(Y/N) r SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
10 Applicant Name Street Address
Sz�c A�hQr //07/6-
11 Zip City State Phone
9t5 0 pOt t41 � (� G ( I 90i-g�,t I
*
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.) r
Fast Track
Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION# '7 'D 3 `?S
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:
E 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:
ci
`°❑ Project Representative Telephone
Agencies Performing Special Inspection:
c 1.
Y O
U
LT co
►- E 2
o
i0 'E-
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Sol
!4
/2
w 10 5' t. 1105'
5.- c
1::b:r act) sva- 7o'I o -0
\J
r