1985, 04-26 Permit App: 00005123 Garage BUILDING PERMIT APPLICATION WORKSHEET
i 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 Use Only
/ Ta+( e E€ Ft... Comm
Road 2 Project Address(not Mailing Address)a Name Space Zip
_ I4 c1 t 0 4 ix`k-e-✓ , A-u-F . c03 '7
3 City/Col munity State Subdivision/P, ! ,t_Name
/Parcel
(^J d?-170,)
4 Assesso Parcel No. Lot Block
26 1 1 — o 3 3 / * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.M Zone (0.1.-s.
t No.
60/
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
0 1 ( I eO
7 Set Back-Front I(L)S-1 (R)S-2 i Rear ) Census Tract Module No. Initials
o ' S �-s JUN rn .
*
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Luel( (& s- = 6.7o € / ( -
Zip City I State Phone
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Contact PersonLicense No. Phone if different than above
/
8 Owner/Agent(if different than M1 above) �/r/J Business Address
7 /
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work E Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo E Add/Alter ❑ Move
14 Describe Work . I
(6 c1 CE C/ � 3o 3d4
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;
APPLICATION#
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; I I
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:
o.
c
c6 Project Representative
Telephone
0. Agencies Performing Special Inspection:
�c o 1.
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T To-
`— 2
CO `o
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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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