BROADWAY E 5414 GRINALDS- STORAGE ADD
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BUILDlh1G PERMIT APPLICATION WORKSHEE7
PLE►4SE PRINT AND COMPLETE ONLY THOSE PARTS Ol~ THE FORM 1'OU UPJDERSTANQ
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{Please return this original and ~our building plans to the Departrnent n# Buflding ar+d Safety}
1 {~wner's Name i) (#frat) ~rn} ~arfm8fli ll9e Or11y
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2 Proj~ AddresS (not Mai llnq Address) [x Fta,ad Nam S~a~e Z€p
•~~"I ~A f~ r` • . ~ 0r cl
3 Uty~C+ommunJty $late 5uhdivisi4nlPla# Narne
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eAssessor Paroel fVa. Lof ~ Block
~ ~ * f MPARTMENT U3E QNL'~
<q 5 314 - ~ 0 4
~ ~c Cbd$ - ZDne Act . ~ ~~)acf No.
8 Ue+efl N No. af Bulldings ' Sq. Ft I Acra Depth Frontage
t qoo` 7100k
TSo Bac4c-Fron# {l.),-1 r(R)S-2 R~ar $ Consue Tract Mo€iu19 No. 4nitials
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* 16 RrchiteCt Flrrn Narne Street Addrass '
Zip ofy 5tate Phone
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c1nt8Ct perspn Phone {f dlfferent 9han abave
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Oontracter FIrm Name Sireet Addreas
6 9 II~ ~L -IF -y 52-1 ~ ~I~..~ •
Z1p Ciky SIeLte Phan e 6;21 a
CbnW pWaon License ka_ Phone It differsnt than ahave
9 DwnarlAgeni (If differ9rli khan 41 aboVe) Busin9ss Address
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9 ~ip Giky 5tafa Phone
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12 F~evlew Required Flan CheCk ~N) ❑fher (Y11+1~ SEP# Exernpk !hl) Q~3te
15 TyqB V'VOrk ' Bldg ❑ MH 0 New i FkeplaC2 Other
C7 ri►e (71 pemo ~ AddiAlter ffD hAnve
,a aescribe worK jzp 2cl'~iC}~
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10 AppfiGant IVafY18 Str6et Adc3ress
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1 i Zip Cixy ~ ~$t$iP Phone
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Lender 5treet Address
,ZIp Ci#y 5ta1e Phone
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CantacS Person Phone ii diffierenk khan abpve
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Adtlltdanai f`".'U. M3.:-
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DEPARTMENT APPROVALS
This is not a Permit
Applicatlon Type ~
(Standard unless (Indicated approvals requlred In either ^release" or "release with conditiona"
otherwise indicated) space prlor to permit Issuance.) ~
~ Fast Track Release
Early Start
ReEease w/cond 1 Hold 2
Environmentel Health Q"Commerclal; p Reside tial ~
W. 1101 College D New Constructlon; O Bldg a eration/add(tlon
Room 200 Ef Additional a uctu e; '
APPLICATION #1
Conditions l Comments:
Planning/Zoning: jg Commerclal; O Cert. of Exemptlon; O Frontape; '
N. 721 Jefferson O Setbacks; O lot w/d; O lot eize; D uselzone; O CU, variance, zone change; shorellne; O fence;
Other '
Conditions/Comments: A
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~ Erigineen: ~ Commerclal; O Residential; O Flood Plaln;
9
N. 811 Jefferson D drainage ❑ new access/approach; 0 fence;
O road improvementa
Conditions / Commenta:
~ Uttllties:
N. 811 Jefferson
Conditions/Comments:
.;>:F~ jpIQ`
~ Other: 4~
(.A;P" 2I n~. P-A5 v tcw i+v
~ ~(Z;;, 2 rN Lk X. ol~ Ac--A.A, w.L ►-1 cA, w-
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~ Plan Exem
Fire Prev.
Condit(ons/Comments:
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Pro)ect Representattive Telephone
~a Agencies Performing Special Inspectlon:
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3.
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ve to tinel as bullt approval
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bOV9 or at[ach condlflQr 2 Indkat
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- BUILDING PERMIT APPLICp►TION WORKSHEET
' 'PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
, (Please return this origlnal and your building plans to the Department of Building and Safety)
1 Ownerb Name ~t) (Iirst) (m) pepartment Use Only
~ ~ pas. ~ Comm ~
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2 Project Address (not Mailfng Address) a Road Nam Space 2ip
.S'"AJ."t v -E • G1 `1 D I `1
3 Clty/Community / State Subdivlsion/Plat Name
4 Aaseeeor Peroe! No. Lot Block
4,5~41 ` /.l O~ r w DEPARTMENT USE ONLY
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5 SkCode Zone Act. N 2one Project No.
g Owell N No. of Bulidings Sq. Ft./Acre Depth , Frontage
1 q~o SDO,
7 Set Back-front (l)S-1 (R)S-2 Rear ~ Gbnsus Tract Module No. Initials
Y N~ ~ - 3z J o NY/~).
16 Archltect Flrm Name Street Address *
Zlp Gty State Phone
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Gbntact Peroon Phone If dlfferent than above
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Gbntrector Flrtn Name Street Address
N Pr(- P s.4F~ N`,' -F- S~ t skrW~ G%r.J E pX •
Zip ~ Gry State Phone
~ ~ ~ ~ ~ Z S; r & 2, 0 I
Contac! Pereon Ucertse Plo. Phone If dNferent than above
e`r.- • ( )
~ 8 Owner/Agent (Ii difterent than Ni above) Buainess Address
9 Zip Gty Stete Phone
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~ 12 'Review Required Plan C•heck (Y N) Other (YIN SEPA Exempt /N) Oate
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15 Type Work ~ Bldg O MH a New ❑ Replace O Other
Y' O Flre ❑ Demo ~ Ad0lAlter ❑ Move
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14 DesCtibe Work
aA4~„ -2-c 16'00
T10 Appllcant Name Street Aadreas
11 Zip City State Phone
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~ Lender Sireet Address ~
Zip Clty State Phone
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Contact Person Phone if different than above
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Addltional Informatlon
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DEPARTMENT APPROVALS This is not a Permit Application Type . ~
r (Stan,dard unlbss (Indicated approvals requlred In either "release• or "releaee wlth condltiona"
otherwise indicated) sp$ce prior to permit issuance.) - ~
+ Fast Track
p ~ly start RBl~►se ,
Retease w/cond 1 Hold 2
t ~I
13 Environmentai Health VCommerciai; O Residential ;
~ W. 1101 Coll '
efle O New Construction; p Bldg alteratlon/addition
Room 200 Additional atructure;
APPLICATION # ti
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•,.,Condltlons/Commenta: • ~
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Planninp/Zoning: 0 CommerGial; O Cert. of Exemptlon; ❑ Frontaye;
y•S N. 721 Jetferaon O Setbacks; O Fot wld; D lot size; O uae/zone; , ,
R, O CU, variance, zone change; shoreline; 0 fence; - ;
. ,
~ D Other
+ Conditions/Gomments: ~
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, • .
~ Enginsar4: ~ Commerclal; O Residentlal; O Flood Plain; ~
a • N. 611 Jefterson O drainage O new access/approach; 0 fence;
J.
' O road improvementa
k.. Condttions/Comments:
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; N. 811 Jeffersan
ConditlcnslCommenW, . f
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ll-~LarZ~ . r-P 1~ prtc.~,vK L r~c& A,-, t *7- 245~ ` .
~ ~ ~Plan Exem . . _ ' 1 .
Fire Prev. - w•£' ~ .
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; CortdlUona/Comments:
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ProJect Representative Telephone -
~ AgencJes Pertorming Special tnspection:
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~1 Indkato ebove or attach condltlona relative to tinal aa bullt epproval
• 2 Indtqts abovs or attach rasona tar hold
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Contae[ Persun Name~A/ _jQY J1, Ds liusiness Name~~~0~Lc' _Q_F~~
Add re s s. 5q1, L( ~.F:, Z.8._4 AZAd d r e s s,5 Sylq ~~.d~2,~nc,a A~✓
Phone Phone
County Contact Persan G-, S~,~J Phone No. 456-3600
CUMMEKCLAL Bt)ILULNG PEttMIT REVIEW
This building permit review is intended to appraise you of the improvement5 (roadway, side-
welk, curb, Stormwater, etc.) which must be constructed in association with your building
permit. Thie checklist will he filled out by the Engineer's staff and a copy will be re-
turned to you at the time that Che permiC is initialed by the Engineering I3epartment. All
requirements shall be completed prior to issuance of the building permit. All unchecked
boxes require additional research or information to make a determination.
1. Stormwater Drainage Considerations
I. pet gufTeMnea tor ntormwater Management 1981" both on and off site.
1. 208 Considerations* M/Yes Li No
2. Flood hazard zone considerations** Li Yes t7~/ No
3. Storm Drainage Plan Yes Li No
II. Plannin& Action #
1. Rezone, Conditional Use or Variance on property ~ Yes Li No
2. Are requiremente of plaaning action incorporated ~ Yes Li No
into eite plan
III. !Uht of Way
1• Does permit necessitate R.O.W. dedication ~ Yes ~ No
2. Dld zone change require R.O.W. dedication ~ Yes VNo
3. Radiue at corner ~ Yes IY. Count,y Road Improvementa
1. Roads need to be improved. How wide Li Yes ~ No
2. Curb Li Yes ~ No
3. CRP/RID agreement (Copy of deed, contract, or Li Yes ~ No
title report required.)
4. Plans for improvements provided ti Yes t~/ No
5. Sidewalk Li Yes No
V. Parking Plan b Approach Location
1. Review and sign of f by Traff ic Li Yes td No
2. Approach Pe rm.i t f rom Eng inee r' s Of f ice Li Yes ~ No
3. State or Ci ty sign of f ~ Yes No
4. Is this road on b Year P1an ~ Yes ~ No
VI. ULIU Agreement: Li Yes ~ No
VII. Fi.eld Review: E'reliminary Comments ~L 0/11~5 _Q/~
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* All l.and wiciiin Che Azliiiter Senslkive Area, wliere cieemed feasible by c.lit_ C~)~~~ILY Filgi-
neer, shall iiicorpc,rare tiCurmwareC tCr:atmetir tn mitigate tlie potenCi:-1I tor gro<<ndwACei'
c1i,-A<1a t ion. (`'Pe l;ii i~Ic~ I i,ie5 f or St,~riuw:~Cer Manr~~~i:rnenC 1981, 5~~~~k,in~• li~~,~r~~ c~f C;c),iiIt y
C;~mmi ss i~~tie r ' , t~ ~►1 itC i ~~n No. $11-1 Sy2 , samen~le~1
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