1984, 05-21 Permit App: 00000518 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 Owner's Name (last) (first) (m) I Department Use Only
1-/A ) Si- 1 I° 7-1-1011/111s `
Vf Ras. Comm
2 Project Address(not Mailing Address)cr Road Name Space Zip
i/i 171 5. .2S7 1/4VJ 99Rc.D (-,
3 City/Community State Subdivision/Plat Name
(-)pPoRT-UN/ i Y WAS_ CS /<6 ,00
4 Assessor Parcel No. Lot Block
* * * DEPARTMENT USE ONLY * * *
1 . ...1 - 3i) 0 -1 7d--6 3
5 Sic Code Zone Act.# Zone Project No. -yam
• 6 Dwell# No.of Buildings -Sq.Ft./Acre Depth ' Frontage I
toe
\, 7 Set Back-Front I(L)S-1 (R)S-2 Rear 1 Census Tract Module No. Initials
* 16 Architect Firm Name Street Address
NCA
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
N /A
Zip City State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) 1SEPA Exempt(YIN) Date
15 Type Work Bldg ❑ MH l New 0 Replace 0 Other
❑ Fire 0 Demo 0 Add/Alter 0 Move
14 Describe Work 1
10 Applicant Name Street Address
SP1n,1 C
11 Zip City State Phone
( ) Gid .,7' 7
* *
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.) r
Fast Track
0 Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential
41-73/-W.1101 College ❑ New Construction; ❑ Bldg alteration/additionRoom 200 ❑ Additional structure; j'a`"
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;
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.
-E❑ Project Representative Telephone
ca Agencies Performing Special Inspection:
c 1.
Y O
C.) '
R
I- E 2.
y O
V_
_
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold