Park N 2521 Convert Convent to Day Care
4-
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRiNT AND CdMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this original and yaur Duilding plans ta the Department of 8uildinp end Sately)
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4 Aaaeeew Parael No ~4y 1101 ~ 3 etaN
~ • 6 ♦ OEPAfiTMENT USE ONLY ~ * *
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s sie amo zone aae r zone Pro(ect No
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8 C~well M No of I!,10d.-Ings Sq Ft I Acte Depth Frontage
7 9et Badc-Front (L)S-1 (pl&2 Reat Oenaua Tract Module No tielo
• 16 MWtM Slreet Addrese ~ •
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contad p~n Uosnge Na Phone fi different than above
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8 OwnetlApent (If diff t N'I above) 8uelness Address
g Zip oqr 81ete Plwrte
( 1
12 Review Requlred Pian CRedc (Y/N) 01her WN) SEPA Exempt (Y/N) ~~Qete -
15 Typ9 V1lwk Bldg I"° MH ~4ddlAltsr ew Other
~ Fire Oemo +C' Move
14 Oescribe Work
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10 Appi(car►t NWne Streel Address
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Addlttonal Informatlon
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DEPARTMENT APPROVALS
This is not a Permit
Applicatlon Type
(5tenderd unle98 (Indlcated approvals required in either 'retease' or "release with conditlona"
othenwlse Indicated) epace prlor to permit Issuance )
C] Fast Track
Earty stan eM~
Rele e wlcond 1 Hotd 2
Envlranmsntsl Heallh C-! Commercisl, L _ ResideMlal ~✓i ~ 1
W 1101 College 11 New Construction, f' Bidg alteratton/additlon ~
ROOm 200 n Addltionel structure,
APPLICATION #
Condltlons/Comments p to-z- igm "g:ff- ybeAt; - -7*j -,3.~30
~i ~l~ ~ • ' r t~t.[J
Plsnnlnp/Zoninp: 0 Commerclal. 0 Cert of Exemption, C] Frontage,
N 721 Jefferson C] Sotbacks. 0 fot wld, 71": lot slze, ❑ uselzone,
❑ CU, varlance. Zone change, shoreline, 0 fence,
0 Other " Let
PREL
Condittona/Commenta U ~ ~t Cr~ c C%QW
~ °t~ r` - • liK~ C'IL') i
, 0 t--
_A'-f'! 2_C 3 T St- -Sc Z-_ '
~ Enplrmrs• O Commercial. ❑ Residential, U Fload Plain.
N 811 JeNerson Q drafnage Cl new accesslapproach, O fence,
0 road improvements
Oondltlons/Commenta ~,~C
~ UNNNp•
N 811 JeHerson
Condltlons/Comments
~ OtMr:
~ El Plan Exam
Flro Prov.
Catdltions/Comments
a
ol
ProJect Representatlve TelepAone
~ Apenclee Performinp Special Inspection
~ C
.9 O '
~ =
to
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~ 0
U. G .
s
1 Indkate above or atlach condiflons rslstlve to ilnal aa oullt approval
2 Indicats above or slt8ch reseona tor hold