1985, 09-14 Permit App 00004545 Decke
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)
1 Owner's Napa,
r'
2 Project Address (not
/ / /,- )
ddress) or Road
(first)
Space.
1
(m)
Department Use Only
Zip—
(0/(1{-
Comm
3—qty/Comnlunity -- -
' /7-6- / (7i/
State
( ±7<
Subdivision/ Plat Name
4..i ir^Clt iii Ir�Cei i.. (J`r,l/_
6- Assessor Parcel No. -,
-.
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone Project No. `
� -
(-/
6 Dwell #
I
No. of Buildings
1
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2® Rear
Census Tract
Module No.
Initials
reef Address
Zip
City
State
Phone
Contact Person
Contractor Firm Name
Phone If different than above
)
Street Address
Zip
City
State
Phone
)
Contact Person
8 Owner/Agent (If different than #1 above)
License No.
Phone If different than above
)
Business Address
9 Zip
12 Review Required
15 Type Work
City
Plan Check (YIN)
a Bldg
❑ Fire
O MH
❑ Demo
State
Phone
)
Other (YIN) ! SEPA Exempt (YIN)
❑ New
'S. Add/Alter
O Replace
O Move
Date
0 Other
14 Describe Work
111
10 Applicant Name
Street Address
11 Zip
Lender
City
State
Phone
)
Street Address
Zip
City
State
Phone
)
Contact Person
Additional Information
Phone if different than above
)
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
Room 200
Conditions/Comments
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
APPLICATION If
Release
Release
w/cond 1
Hold 2
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone:
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/ Comments•
Engineers: 0 Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; ❑ fence;
O 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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