1985, 07-05 Permit App 00006216 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)
6
1 Owner's Na e (last) (first) (m) DepartmentU my
/ —sue- —c---7—'
Res. Comm
I
11
2 Project ddress (not Mailing Address) oad Name Space Zip
3 City/Community
S ,;,
State
r^= 0-
Subdiv ion/Plat Name
v
4 Assesso Parcel No.
�Q5 , / / _ f�3(.' 7
`? `r /
Lot
7
1 Block
I /✓
C'
* * * DEPARTMENT USE ONLY * * *
5 SicCode
Zone Act. #
Zone r
4? i
Project No.
6 Dwell #
No. of Buildings
y-
Sq. Ft./Acre
Depth
/.S'e
Frontage
/ % 0
7 Set Back -Front I (L)S-1
g 19
(R)S-2
.5-3
Rear
i
Census Tract
I Module No.
Initials
M (..v
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
ntractor Firm Name /�
^--vim-' �u v% o` D 1
Street Address
//,5.7 '',/ r itte..L_
Zip
19,2 d G
City
rUcense
State
L., a_ .
Phone
( ) 9,2,-.2-z ‘
•c,ontact Person
No.
Phone if different than above
8 OwnAgent (if different than #1 above)
JJJJ
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
[SEPA Exempt (Y/N)
Date
15 Type Work ❑ (Bldg
d Fire
❑ MH
0 Demo
>.New
0 Add/Alter
❑ Replace
0 Move
❑ Other
14 Describe Work
/
10 Applicant Name I
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
*
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
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 N (
Conditions/Comments-
Release
Release
w/cond 1
Hold 2
AUL
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:
Plan Exam
Fire Prev.
Conditions /Comments•
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
/%o
i
�z
68/
.A -se 72,5' Ka,67'
79_
59�
5i,
/50
N