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1984, 07-11 Permit: 00001111 Residence W/GarageSIC"JATURE OF 4PPL/Cx vN OWNER OR AGENVX L 1 114 A At DATE STRUCTURE Descrip -tinn Square feet Description Square feet Description Square feet Est Pln Chk STRUCTURE 01139 1/84 00001111 Structure Fee $346.00 11 INI $346.00 x PLA N DWELL Croop -3 001200 Occopancy Loa' 0000 DWELL.UB Group R-3 001200 Occupancy Load 0000 N PRI CAR WF Group M-1 000460 Occopancy Load 0000 $0.00 Actoal Pln Chk PERMIT Type VN Type VN Type VN $0.00 Var 7 O -ll~8 � .. ^� ". TOTAL FEES $346.00 $0.00 ~ IL Ui LL LL 5881 6 * 3468O� ' - `~ ffS: ,-.F j 08 E ALKI AV 'UIUU�BER CONSTRUCTION J0 y .4-41014 INS INSPECTOR: "W2544 5 STRUCTURE Descrip -tinn Square feet Description Square feet Description Square feet Est Pln Chk STRUCTURE 01139 1/84 00001111 Structure Fee $346.00 11 INI $346.00 x PLA N DWELL Croop -3 001200 Occopancy Loa' 0000 DWELL.UB Group R-3 001200 Occupancy Load 0000 N PRI CAR WF Group M-1 000460 Occopancy Load 0000 $0.00 Actoal Pln Chk PERMIT Type VN Type VN Type VN $0.00 Var 7 O -ll~8 � .. ^� ". TOTAL FEES $346.00 $0.00 ~ IL Ui LL LL 5881 6 * 3468O� ' - `~ 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 Name (last) (first) (m) ` L� — i — Dspart Use Only 2 Project Address (not Mailing Address) or Road Name j Figs. V Comm .s C + t _33 CD-Z_- A Space 9-Ni, Zip 3 1 City /Community State Subdivision/ Plat Name 4 Assessor Parcel No. Lot Block _ * * * DEPARTMENT USE ONLY 5 Sic Code Zone Act. M Zone Project No. j J 6 Dwell ti No. of Buildings Ft. /Acre Depth Frontage 7 Set Back :Sq. -Front (L)S -1 (R)S -2 Rear sus Tract Module No. In'tials * 16 Architect Firm Name Street Address Zip City State Phone Contact Person Phone if different than above Contractor Firm Name Street Address L_ 1 v LK `mac-" e Cep .<ti S Zip City State Phone Contact Person License No. Phone if different than above 8 Owner/ Agent (if different than #1 above) © t Business Address g ZIP City State Phone 12 Review Required Plan Check (Y N) Other (Y/ N) SEPA Exempt (YIN) Date 15 Type Work Bldg ❑ MH New ❑ Replace ❑ Other ❑ Fire ❑ Demo ❑ Add /Alter _1 Move 14 Describe Work Tz-,A 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 N F C n e. � u CL _0) Y U cU H CU CU LL DEPARTMENT APPROVALS i indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold Application Type I his is not a Permit ❑ (Standard unless otherwise indicated) Fat Track (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ arly Start Release Release w /cond 1 Hold 2 Environmental Health W. 1101 College Room 200 /Commercial; Residential New Construction; ❑ Bldg alteration /addition ❑ Additional structure; APPLICATION # Conditions / Comments: ❑ Planning /Zoning: N. 721 Jefferson ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; ❑ Setbacks; ❑ lot w /d; ❑ lot size; ❑ use /zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/ Comments: Engineers: N. 811 Jefferson ❑ Commercial; Residential; ❑ Flood Plain; ❑ drainage jy�°/new access/ approach; ❑ fence; ❑ road improvements Conditions/ Comments: ❑ Utilities: N. 811 Jefferson Conditions/ Comments: JI ❑ Other: ❑ Plan Exam Fire Prev. Conditions/ Comments: Project Representative Telephone Agencies Performing Special Inspection: c O 1 Co E o` 2 C: 3. i indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold SIGNATURE OF OWNER OR AGENT JOB ADDRESS: iiII L,1 Iv OWNER: ADDRESS: CITY: ST: ZIP: APPLICANT: CONTRACTOR: ADDRESS: CITY: ST: ZIP: PH: LICENSE- RCH /ENGINEER: ADDRESS: CITI ST: ZIP: PARCELS: CENSUS TR: INSPECTOR: PLAT.: LOT 11: BLOCK FINAL PLAT NAME: ZONE.: ZONE FSB S-i 5-2 RSB MOO USE OF PERMIT: 1101 ADDRESS: Ave APPLICATION DATE SEQ. FEES: PAID BY: CA �.IC COUNTER APP. PLANS EXAM: ATE: a O U w O U w CL U) z \— \ ` ( KS FTGS 4,_ 3 STEEL 4 PROGRESS 10 ASSEMBLY 11 FIREPLACE 12 EXTERI'OR 13 DRYWALL 14 EXT. GRADING �15 FINAL P16 GRD PLBG. 17 WATER PIPM�6__ 18 DWV TEST 19 IXTU 21 SEWER 23 PROGRESS 40 GAS TEST 41 FURNACE 42 DAMP 43 INLEVOUTLET 144 cOMPBUSTION 45 COMPREqqoR_._ 47 FIRE DAMPER 49 HOODS 50 PROG 51 FINAL 52 FINAL INqP F53FiREPRE ENT, �E 54 �PANCY/T�i ERS RES 47 FIRE DAr, 48 SMOKE D HOD DS 155 REQUESTED 58 COMPLAINT/Zp��E__ PL 59 COM ,o COMPLAIN ---HER —_l- �| 0 ~ U) a m � —| � r- |