HomeMy WebLinkAbout1984, 04-10 Permit App: 84A-3262 Residence •
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)„lI Department Use Only
SC,//E.9 A1A/Y ff0/ '•QT Res. Comm
2 Project Address(net Mailing Address)or Road Name Space Zip
i\ 1 \ t.u . Loi y e../. /
3 City/Community State Subdivision/Plat Name
S>:'a A4-011 eV r 2..-4 f it/• r/J/L (1,04—,Z° 2 no/ 4dC1
4 Assessor Parcel No. Lot Block
3 3 5 u / + "e, / * * * DEPARTMENT USE ONLY * * *
1,, 5 Sic Code 7 Zone Act.# Zone Project No.
SFS
A 6 Dwell ii No.of Buildings Sq.Ft./Acre Depth Frontage
-
T 7 Set Back-Front (149-1 (R)S-2 Rear i Census Tract Module No. Initials
” 1 ..,.3' / L.
* *
16 Architect Firm Name Street Address
"i*1 i'
Zip r City State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm Name Street Address
—CC/4//,` .-.'A/S/ C OdY l 7, C 2 6 O 2. t 4e`. det' ' "..*7,i,
Zip CityState Phone
9 ei 2 / Z if a 0 I [...---of r /V ( 4 ) 2 - e4 :.. / k`
Contact Person License No. Phone if different than above
,/t?47r ri t. INCA "A*AY 1 oe,e-"Z SC / 7 f /f'0,4D` ( )
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(Y/N) Date
15 Type Work f.. Bldg ❑ Mki ,: New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( 1
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
E 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; 0 use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; C] Residential; ❑ Flood Plain; 1c)0//t1N.811 Jefferson ❑ draina e e new
9 access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
a
N
C
`°, Project Representative
Telephone
a Agencies Performing Special Inspection:
O c 1.
`- E 2
7) o
as
u
3.
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
S
N
�
1
1
CheU -
38:.0.
�5..
2zx22
__DRu_v_ YYi4Y