1984, 12-12 Permit App: 00003704 GarageBUILDING 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)
G 0 C) L` E .<
(first)
Cf---
(m)
Department Use Only
Res. Comm
2 Project Address (not Mailing Address) or Road Nam''eTT
iN
Space
Zip
3 City/Community
State
Subdivision/Plat Name
O PP0r?-T(.)l,%1 0F
6&I
4 Assessor Parcel No.
�-4 _
Lot
Block
* ♦ + DEPARTMENT USE ONLY ♦ it
5 Sic Code
Zone Act. #
Zone
/
Project No.
6 Dwell #
No. of Buildings
Sq. Ft./ Acre
Depth ) +
-,314 —
Frontage
wo' +
7 Set Back -Front
� JTI
(L)S-1
(R)S-2Rear
Census Tract
Module No.
Initials
-,A
16 Architect Firm Name
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
Contractor Firm Name
Street Address
Zip
City
State
Phone
Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Sk<wC-:-
Business Address
9 Zip 9G ?,-Oce,
State
Phone ) (mil ^ ��
12 Review Required
Plan Check (Y N)
Other (Y N)
SEPA Exempt (Y/N)
Date
15 Type Work >f, Bldg
1-1Fire
❑ MHNew
O Demo
❑ Add/Alter
-1 Replace
❑ Move
EIOther
14 Describe Work
10 Applicant Name
Street Address
11 Zip
City
State
I Phone
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
Additional Information
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
1 1110 IJ I IUL Q r-Gl 11111
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
Releasew/cond 1 Hold 2
_
Environmental Health
1.;2- `
❑ Commercial; ❑ Residential
W. 1101 College
❑ New Construction; ❑ Bldg alteration/addition
Room 200
W Additional structure;
APP I TION #
Conditions/ Comments:
' 6 r
El
Planning /Zoning:
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson
❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/ Comments:
Engineers:
❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson
❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/ Comments:
Utilities:
N. 811 Jefferson
Conditions/ Comments:
❑
Other:
El
Plan Exam
Fire Prev.
Conditions /Comments:
Project Representative
Telephone
Agencies Performing Special Inspection:
1.
o
E
`o
2.
' C
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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