1985, 04-16 Permit App: 00004971 Storage Bldg 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) Department se Only
Q
JJ A- Rte lU 1..- O v Aire/ 0. Res. Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
q n_ i -� 991,_-Y
3 City/Community State Subdivision/Plat NaTt
1/gffiVii4 l y1/ic Ve cc ("hertz( Acre,
4 Assessor Parcel No. . Lot Block
n C/_ ,t ,t * DEPARTMENT USE ONLY ,t ,t +
eS -35�S j
5 Sic Code Zone Act.8 Zone Aa Project No. /g
Kt 4r i
6 Dwell4 No.of Buildings Sq.Ft./Acre Depth Frontage
/3o00
7 Set Bads-Front 1(L)S-1 (R)S-2 !Rear
Census Tract Module No. Initials
* *
16 Architect Firm Name Street Address
actin 13, M,4 Aw -A _11SSeC i Ths /V-I1c6 G,`t/itr- _.1;-,01C pg
Zip City State Phone
C6GbT h/R. ( ) -d'7'`ID
Contact Person Phone if different than above
Contractor Firm Name // Street Address
Zip City State Phone
9C7 7 0775 4,nads WA. ( ) 9a4-/‘.-L- 7
Contact Person License No. Phone if different than above
--e, h ri e(5/,1-r 'ted e A4 J,29.,J ( )
8 Owner/Agent(if different than 41 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work GI--Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
f LE / .(4o' S're,iFi4e,"&
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.)
❑ 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;
APPLIC TION#
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:
a
c
i°' Project Representative
Telephone
a. Agencies Performing Special Inspection:
co
Y o 1•
U
~ 2.
N
LL
C
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
COOK BROTHERS CONTRACTING JOB L2%DIV'0'9/ur •. --ti;)ffk /,1/1/ /'Qf
Route 2 Box 853 B SHEET NO., .-/41 9E Q / - of J/ 1-1:1'(114---)I `A4,
OTIS ORCHARDS, WA 99027 �y�// r
(509) 924-1557 CALCULATED BY 1�_4) X P7` 1 DATE
CHECKED BY DATE
SCALE
LAG
• ' " NI
V .od, Go0h . «,i19e. ei7.0 ere_ 362
35 -.1.16 B.
{
.._ _ ...... ..._ _ _._. _.. 5161 1' •
___ ._.....
I
cppetx.
w '^" '
4.
i
I'
5As9
r
i
V
FORM 204 Available from( EBSI INC.Townsend,Mass 01470 `s'_ - /00 1--