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1984, 05-10 Permit App: 00001385 Garage 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 OwnerV \ (last) \!- , ' (first) 1(m) Repartment 11 Only \1� � _`�`}t Ids. ✓ Comm 2 Project Address(not Mailing Address)a'Road Name Space , Zip I1f2-19 I ?7`^ 0,Re4)e\ Ubs� 9` 037 3 City/Community State Subdivision;Plat Name 1—÷---(446uJ 74 ( l'AK-\c 4 Assessor Parcel No. Lot Block o/_5 4-z D70-z- go cc, * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.k Zone Project No. 6 Dwell 4 No.of Buildings Sq.Ft./Acre Depth Frontage �.._2__ ZS oc)443 l Z'S i.Esc 7 Set Backk Ffpntr I(L)S-1 I (R)S-2� RearCensus Tract Module No. 'l> lals . * 16 Ar Firmtame I Street Address * Zip City State Phone ( ) Contact Person Phone If different than above ( ) CoQlrictof tl' Sv:: :t_;\\____N Street Address 1.1 Zip City State Phone ( ) c(,24- 378 7 Contact Person License No. Phone if different than above 8 Owner/Agent(if different than 41 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Othe`�r /N) ISEPA Exempt(YIN) Date 15 Type Work V Bldg ❑ MH New ❑ Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work ,w63ot`{ 'fo ' GP't1014� 10 Ap nt NanirStreet Address U tS (1,-)' ..."---?:)t)v� SA vv. asp A. 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.) fl Fast Track ❑ Early Start xRelease Release w/cond 1 Hold 2 Environmental Health ❑ Commercial; �' Residential l /� .r W.1101 College ❑ New Construction; ❑ Bldg alteration/addition v, /-t S. �IY�6i Room 200 El structure; 777 APPLICATION# Conditions/Comments: O Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; El lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; El Other Conditions/Comments: Engineers: ❑ Commercial; Q esidential; El Flood Plain; �� . N.811 Jefferson ❑ drainage new access/approach; ❑ fence; �' // "� 9 , El road improvements Conditions/Comments: D Utilities: N.811 Jefferson Conditions/Comments: CI Other: Plan Exam Fire Prey. Conditions/Comments: a en c --❑ Project Representative Telephone fa Agencies Performing Special Inspection: Y O c 1. m cz 1` E 2. y o m c U 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold FF p,CED t ' �' A r1. u NE to CN8RAc,F F/3�F -- - - --- -- --, o. 4.____20, i ,,S M---- 30' • /AS' ..—j —4, - 1-ii- 17 1 it. �' I' HouSt c �Gt £.19a19 r /.0. -a% v V - i7 Curt+is 11.). bo-oth LEnEN AtRPARt~ L 20 Be RRC .( 4. 1 yo SctilE / MM .- I Foot