DESMET E 6102 B LINE TRANSPORT STORAGE BLDG
~ 1-11114
BUILDING PERMIT APPLICATIQN'\IVORKSNFET .
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Ptease return this original and your building plans to the DepartmPnt of Building and Safety)
1 Owner's Name (last) ((irst) (m) pwart~, ~~Y
~-lN~? ~l'2.A,NU 2'T ( Comm 6111'
2 Project Address (not Malling Addresa) or Road Name Space Zip
t• Cc 1 UZ ~,-c A~V iF, G~CAa.c
3 GtylCommunity State Subdivlsfon/Plat tVame
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4 Asseaor pg►Cel No. Lot Blpck
DEPARTMENT USE ONLY **,t
5 Sic Cade Zone Act. M Zone Project No.
Nt~ G ~E
8 Dwell N No. ot Bulldings Sq. Ft./Acre Depth Frontage
3 Ac~s d~t~' '
7 Set Badc-Front (L)S-1 (R)S-2 Aear Oensus Tract Modulo. I~1s~ `
6 ~
*16 Archltec2 Firm Name Street Addrass *
f,.~otv AyC<, R- ~ : 4 i~-
Zip Gfy State Phone
aa O-`-2-- Q-55T) 6-2t~
ODntse Perso^ Phone If different than above
,_)i O N
Contractor Firm Name ' Street Address
ZiP Gty State Pfione
' (5CQ
Contact Person L(cense No. Phone if different than above
1
8 OwnerlAgent (if different than 1l1 above) 9usiness Address
9 Zip City State Phone
f )
12 Review Required Plan Cneck (Y/N) Other (YfN) + SEPA Exempt (Y/N) Qat@
15 Type Work i Bldg p MH New C_' Replace Other
Ci Fire 0 Demo C AddlAlter E:? Move
td pescribe Work
y c5 "15C>2+Y1C-l.~
10 AppliCant Name Street Address
11 ZiP Clty State Phone
• .
Lender Sireet Address *
Zip City Stefe Phone
l )
ContBCt Person Phone if different than apove
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Add i t ional I n(ormat i on
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DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvats required in either "release" or °release with conditions"
otherwise indicateU) space prior to permit issuance.)
Fast Track ' Retease
C] Early Start . Release w/cond 1 Hold 2
~
i4 Environmental Health CJ Commercial; ❑ Residential ~
W. 1101 College O New Construction; Cl Bldg alteration/addition ,
Room 200 ❑ Additional structure; j
v
APPLICATION fi ~
ConditionslComments: i
~ Planning /Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson O Setbacks; O lot w/d; O lot slze; ❑ use/zone; ❑ CU, variance, zone change; shoreline; D tence;
❑ Other •
Conditions l Comments:
~ rin. ,
Englneera: D Commercial; ❑ Residential; 0 Flood Plain; u
N.811 Jeffersan C3 drainage D new accesslapproach; 0 fence;
0 road improvements
Conditions/ Comments:
utiuties:
N. 811 Jefferson Conditfans/CommeRts:
~ Other: •
_ T 6~18hw
❑ Plan Exsm
Flre Prev.
Condit(ons/Comments: ~'C~~ P.F~1~.. b1' ~s'~hKl4c~,~ bt~ rhm~~l2iA~~
C ~
Project Representative Telephone
a Agencies Performir,g Special Inspectlon:
N C 1.
Y O
M ~
L.
E
L- 2.
c, o
m c
-
U.
3.
1 Indicete above or attach conditlona reletive to tinal aa bullt approvel
2 Indicate above or attach raesona for hold
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