1984, 05-16 Permit App 00000240 Storage BldgBUILDING 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)
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1 Own 's Name (last (f stt))) (m) Department Use Only
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2 Project Address (not Mailing Address) or Road ame Space Zip
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3 City/Community '
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State
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Subdivision/Plat Name
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4 Assessor Parcel.1( - b 2 O
SS
Lot
I Block
* * ,t DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
� �A
Project No.
6 Dwell #
/
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
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(RUO )
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Census Tract
I ModuleK1
r •
16 Architect Firm Name i
Street Address ►
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name �/�/J -�
-- T.' ' ' l E
Street Address
Zip
City I
State
Phone
( )
Contact Person
License No.
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (Y/N)
SEPA Exempt (YIN)
Date
15 Type Work Bldg
0 Fire
❑ MH
❑ Demo
❑ New
0 Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
3 X 77/ stZ'Z 43
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10 Applicant Name
C�/�n
Street Address
11 Zip
City
State
Phone
(c) Ci es ` 2{� 7,7
1
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
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
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Conditions/Comments
APPLICATION #
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
�I Additional structure;
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Release
Release
w/cond 1
Hold 2
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; ❑ lot slze; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
O Other
Conditions /Comments•
Engineers: ❑ Commercial; 0 Residential; ❑ Flood Plain;
N.811 Jefferson 0 drainage ❑ new access/approach; 0 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
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