HomeMy WebLinkAbout1985, 05-03 Permit App: 00005274 Addition • 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 Use Only
_5147 d/ 4- { i/ : /7-C� L..d Res. ✓ Comm
2 Project Address(not Mailing Address) Road Name Space Zip
,/2 • /0/ ?_3 �
3 City/Community State /- Subdivision/Plat e arc/ ���^/
e 6 �,tiJ L t r,7 C 4 � k-, c r L/
4 'Assessor Parcel No. Lot Block
2fi5i l - /705 S * * * DEPARTMENT USE ONLY * * *
,c 5 Sic Code Zone Act.# �� Project No.
) AG�ue -
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
I i _ "25 C
7 Set Back-Front (L)S-1 (R)S-2 Census Tract Module No. Initials
120 - 'Rear�� , c Aiw
*
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
ContractorlFirm Name //,� Street Address C-7
�J /i
,� C�f 1.1 fl l ' AI �r c (M i Ai (- 1 '`2 G c 7 fF `51 1 i^a C) I J
Zip Cit /f�, I State� Phone
`^ 1 , . t �7 - lW-2,t4 ( ) '-' eV — 1' 7 ,.
Contact Person License No. Phone If different than above
BFcK1-cep 3 r 7 DU ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date
15 Type Work L5 Bldg ❑ MH I "New ❑ Replace ❑ Other
'\--- ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
)-" 32O eS i c/ wC e Acid (F 1 11-
10 Applicant Name / Street Address I
V't e>L7 e'c .i /LL r' /c�O8 "7 f -,r I.--C r) ,'—')
11 Zip City State 'Phone
* Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
5 C 17s / 6 v -- ( )
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 Q. _i
W.1101 College ❑ New Construction; 0 Bldg alteration/addition /3 J
(
Room 200 ❑ Additional:ucture;
APPLICATION a
Conditions/Comments: te
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage;
N.721 Jefferson ❑ Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone; •
O CU,variance,zone change;shoreline; 0 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:
ci
c
C O
Project Representative Telephone
aAgencies Performing Special Inspection:
O 1.
m
E 2.
h o
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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