HomeMy WebLinkAbout1985, 04-01 Permit App 00004718 Garage.s •
*
•
BUILDING 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)
(first) (m)
Department Use Only
1 Owneer'ssN7Namee / _jlast)
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Rai-
Comm
L—1 I C ,47-- --jina(
2 Project Address (not Mailing Address) or RoodName Space Zip
Emil] ejyr.4 Q. H.er�_c..._ c..,t,....g / '9'e /.
3 %G7/Community
Yr+o-PH ne.e-frta r
State
L'(. ,
Subdivision/Plat Name
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4 Assessor Parcel No.
C/ /2 4
0 7s 6'( /0
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. M
Zone
Project No. 4-7 l s
6 Dwell4
No. of Buildings
/
-Sq. Ft./Acre
ctS
Depth
cP 4 e7
Frontage
/FE)
7 Set Bade -Front
(L)S-1
(R)S-2
1Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
1
Street Address
Zip
aty
State
Phone
( )
Con Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( 1
tact Paxson
License No.
Phone If different than above
( )
8 Owner/Agent (if dlf nt than 91 above)
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (Y/N)
Other (Y/N)
jSEPAExempt(YIN)
Date
15 Type Work B' Bldg
0 Fire
❑ MH
❑ Demo
Q- New
0 Add/Alter
0 Replace
0 Move
❑ Other
14 Describe Work
. .11 d (9-/4ro(gyp 203
10 Appl• p ` l
� 0)-r �e /I /it f/-r? C_j-
Street Address
t /0 2 27 u-(1,-,v,.fz
11 Zip �j
/ t�/ 4
City
a> e-e--Pikfae. l_ 4,
State
(1#1
Phone
6-1 ) %,---r -'k/5-.
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
DEPARTMENT APPROVAL
Application Type
(Standard unless
otherwise indicated)
• Fast Track
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Early Start
Release
Release [w/cond 1 Hold
2
Environmental Health ❑ ommercial; 6 Residential
W_ 1101 College New Construction; ❑ Bldg alterationladdition
Room 200 Additional structure;
C.� r.
1
S�
APPLICATION # / /
Conditions /Comments:
Planning/Zoning: ❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone;
1
I i
0 CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/Comments.
Engineers: 0 Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
i
0 road improvements
Conditions/Comments.
Utilities:
N. 811 Jefferson
Conditions /Comments •
Other:
(-4
Plan Exam
Fire Prev.
Conditions /Comments •
Project Representative
Agencies Performing Special Inspection:
1
Telephone
2
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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