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1985, 10-02 Permit App 00007802 Residence, 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) (first) (m) DapartmenttSseOnly 2 (0/1 7)Se-/-"/ ();:,A2 5 / I Res. Comm 2 Project ress (n t Mailing Address) Road Name Space Zip 3 City/Community Sc) ,74 4) E State % 1 S'ision/Plat Name"../ / U pmJDEa20 S 609L/Q! ��PLC 4 Assessor Parcel No. Pri\J •, Cr/, — /e I 1 Lot /3 Block I J * * * DEPARTMENT USE ONLY * * * 5 Sic Code I Zone Act. # Zone Project No. ./7 30C/ 6 Dwell # 1 No. of Buildings 1 Sq. Ft./Acre Depth / 7._ Frontage ISO _Q7 7 Set Back --Front t (L (R)S-2 j Rear Census Tract Module No. Initials L rI 16 Architect Firm Name 574 Al ..6 Street Addr s Zip 99�o City SPo f,,0 / State L1----74 Phone (50?) e/y7_ 7.7 ? 7 Contact Person 0 Phone if different than above Contractor Firm Name Street Address Zip City [State Phone ( ) Contact Person License No. 2,0,un2c1 1�a 4 Phone if different than above ( ) 8 Owner/Agent (if different than #1 above) S4 Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (YIN) Other (Y/N) 1SEPA Exempt (Y/N) Date 15 Type Work ❑ Bldg 0 Fire ❑ MH 0 Demo New 0 Add/Alter ❑ Replace 0 Move ❑ Other 14 Describe Work 10 Applicant Name Street Address 11 Zip City State Phone ( ) Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information nif - f oil Oia = j3001 (Ili AIL ;71 El Application Type (Standard unless otherwise indicated) Fast Track f Early Start Environmental Health W. 1101 College Room 200 Conditions /Comments DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ Commercial; ❑ Residential ❑ New Construction; ❑ Bldg alteration/addition ❑ Additional structure; APPLICATION # D —/I-2-- Release Release wlcond 1 Hold 2 4. .I Planning/Zoning: N. 721 Jefferson ❑ Commercial; ❑ Cert. of Exemption; 0 Frontage; ❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; ❑ Other Conditions/Comments' Engineers: N. 811 Jefferson Conditions/Comments• ❑ Commercial; ❑ drainage ❑ road improvements O Residential; ❑ new access/approach; ❑ Flood Plain; O fence; Utilities: N. 811 Jefferson Conditions/Comments- 0 Other: b7L m U N o. c O Es as O co Plan Exam Fire Prev. Conditions/Comments- Q104- (eNlr Project Representative Telephone Agencies Performing Special Inspection: 1 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold bl 71 Soso-7 [] ko.00 1v Pkfr, of Vcral-itP g✓ y sD23s- A4TM D V30 «7pr1F 89• 5 5 it/'' /6