1985, 06-03 Permit App: 00005714 Storage BldgBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM VOL! UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner Name (last) (first) (ml
pyylms't ly
6/2/23/476 622- G/4�✓F2
Comm
2'Project Address (not Mailing Address) cr Road Name Space Zip
/40e/9&ri4 99zoh
3 Cltyftammpnity
r%—'2)117 ✓E
State//
sv
Subdivision Plat Name �/
NI Qpnl C ,-^ s -M -les -,Y7
4 Aae®r Parcel No.
6r{L/4q -o90L
`/
% !Zana
Lot
2-
Bink
♦ * . DEPARTMENT USE ONLY * **
q _
v 5 Sic lbde
Am.N
Zone Protect No.
SFR 67/V 57/./
6 Dwell N'
No. at Bull Ings
Sq. Ft./Acre
Depth ���. ��
Frontage�
7 Set Back -Front
0.)S-1
(PIZS-2
Rear
Census Tract 1 Module No.
1
Initials'%/moi
CHU)
16 Architect arm Name
Street Address
Zip
City
State
Phone
( )
canted Person
Phone It different than above
Contractor Finn Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Ucenm No.
Phone If different than above
( )
8 Owner/Agent indifferent than Rl above)
SA -S4 e
Bus! em Address
9 Zip
City
State
Phone50 q) 92e-DS/.V
/ 7
12 Review Required
Plan check CON)
Oth r(YIN) 1 SEPA
J
swept (YIN)
DUate
15 Typ.Work a Bldg
❑ Flre
0 MEI
❑ Demo
t New
'Md/Alter
0 Replace
0 Move
❑ Other
14 Describe Work`�i n QQ'
roRAae. Bic/a-2'/X2 1(Q
0tltlrma
10 Applicant Name
11 Zip
City
State
Phone
( )
Lender
street Address
Zlp
City
State
Phone
( )
Contact Person
Phone IIdlflerent than above
( i
Additional information
f
DEPARTMENT APPROVALS
•
❑
❑
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
1 rlls Is nota rermr
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit Issuance.)
Release
Release
w/cond 1
Hold 2
�y/
u
Health ❑ Commercial; 0 Residential
W.EnvironmentalC/
W. 1101 College 0 New Construction; ❑ Bldg alteration/addition
Room 200 0 Additional structure
fiL
; ,��
APPLICATION N 6 ? 97
Conditions/ Comments'
❑
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone'
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments'
❑
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 0 fence;
new access/approach;
❑ road improvements
Gond itions / Comments'
❑
Utilities:
N. 811 Jefferson
Conditions / Comments'
o
Other:
❑
Plan Exam
Fire Prov.
Conditions/ Comments'
0
Project Representative Telephone
Agencies Performing Special inspection:
m
E
2
0
c
3
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
�aa-'Fs yr -M.
a,t
L^
84b tta
— —
,.133Cobd
3J/1a'o1S'l
/41
t,'7'. b/8 o/
�65,9-8r6 '7 L