TRENT E 7403 SIGN .
~
I
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return thls original and your building plans to the Department of Building and Safety)
! 1 Owner's Name (lasl) (first) (m) Oepartment Use Only ~
LLY L ) ! z L pes. + Comm ~
2 Project Address (not Malling Addresa) or Road Name Space Zip
e`~7 74~~-3
3 CitylCammunity State Subdivlsion/Plat Neme
A
4 Assessor Paroel No. Lot Block
Z6 t t r OEPARTMENT USE ONLY w w r.
C) 101 J
5 S!c Code Zone Act. N Zone Project No.
~D3 s~ ~~I~'1 yY1 .
6 Dwell N No. ot Buildings Sq Ft.lAcre Depth Frontage
7 Set Baclt-Front (L)S-1 (R)S-2 Rear Cbnsus Tract Module No. In tlale
~ 16 Architect Ffrm Name Street Address ~
Zip City State Phone
( )
Contact Person Phone ii different than above
( )
Oon ractor Flrm Name ' Street Addreas
9'A A l7 l/" ~
. ZiP Gty State Phone
~ 99-~D .,5~,~ _j-t~~' ~ - 5~~/_.~
i, Contact Peraon License No. Phone If different than above
► A/z L f~ fif//,L L//~1 /y/s • , c ~
8 OwnerlAgent (if different than N1 above) Business Address
9 Zip C(ty State Phone
( )
12 Aevfew Requlred Plan Check (Y/N) Other (YIN) ~ SEPA Exempt (Y!N) Date
15 Type Work O Bldg O MH Q New ❑ Replace ;XOther
0 Fire p pemo C"l Add / Alter Q Move
14 Describe Work t ~ {
~ 'N'O ~.SL
3 ~ .Sc1~t~) -S I ~ ~ -~r-
10 Applicant Name StreefWddress J
11 ZiP City State Phone
( 1
t *
Lender Street Address
Zip City State Phone
. ( 1
COntaCt PersOn Phone if ditferent than above
Additional Information
s ~
DEPARfiMEIVT APPROVALS
This is not a Permit
Application Type
(Standard unless (IndiCated approvals requ fred in either "release" or "release wi#h conditfonsp
otherwIse indicated) space prlar to perrnit Issuance,) r ~
[j Fast Track Release
Early Start Release w1cond.1 HoId 2
~ , .
~ Envirvnmertte# HeaHh El Cnmmercfal; 0 Residential
W. 1101 CoIIege QNew Construction; CJ 81[€g aIter2rtianladdition
Ranm 200 ❑ Addltianal structure;
►4PPLICATIQN # _
Condf tions l Cornmen ts:
_ ,
~ PlenninglZoning; :9 Cammercia#r Cl Cert. of Exemption; L7 Frontage, t
W. 72-1 .1'ef fe. rson O 5etbacks, • Q lat wfd, • 0 lot site, • 17) uselzone-
_ ,
~ 0CU, variance, zone clhange; shorellne; CJ fence;
U O#her
Conditinns f Comrnen#s:
~
~ Ereg(neeraG: ❑ C.ommeFCial; ❑ Residential, ❑ Flood Plain,
N. 811 Jeffersan D drainage ❑ new accessJappraach; 0 fence;
O road lmprovernents
CondItionslComrrnents: • _
. . ~
~ 1.1#Ilitles:
N. $11 Jefferson ~
CondltionsfComrnents; ~
F- I otr,ef: -
,
~ Pian Exam ~
Flre Pror. CanditionsI Comrnents: •
Q,
~
Rraject Representative T$lephana
~ Agencles Per#orrning Special Irtspection: - -
Y p C3
~ ~
F- E
2.
C
lL
3.
I Indicate abave or attach candHfona relatlve to fiinel ais built approval
2 Indicete abGve or attach reasorts for hald
4 /
~ '
. `
1
~ ~o~L ~ ~ , ,
~1d~=~ ti
~ ,
_ ~ ~
i~, , ~ ~ ~ ~
_.,r~•., , . , ` ~ ~ .
~
~ ~r
~i;
~
~ { ~ ~
t ' • 4 1 ~
` ~
, ~ ~
/ I~ 1~ .
~ ~ . ~ ~
~ ~ ' ~ ~ ~
~ t . ~1 ,
. ~ ~ ~
{ .
. ,t ,
,