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1984, 06-08 Permit App: 00000595 Swimming PoolBUILDING 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) Department U my (241 -Ki< J EF'ra>=`i IN *o, x Ras. comm 1 2 Project Address (n Mailing Address) or Road Name Space Zip C iiir5 /-)- r4 Cr `il�OL4, 3 City /Community 0KtAn3 State Subdivision /Plat Name 3 4 Assessor Parcel No. . .x.54' 7 -- � '( Lot Block C( * t * DEPARTMENT USE ONLY * * * L 5 Sic Code Zone Act. # Zone Project No. 6 Dwell # No. of Buildings Sq. Ft. /Acre Depth Frontage 7 Set Back -Front I (L S -1 (R)S-2 1 I Rear ` F-6 Census Tract 1 Module No. Initials I 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Street Address Zip City 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 (Y /N) Other (Y /N) SEPA Exempt (Y /N) Date 15 Type Work .71 Bldg ❑ Fire ❑ MH ❑ Demo ❑ New ❑ Add /Alter 7 Replace E Move ' Other l C C 14 Describe Work vv�y1,-- I ►mac. .- C:-,'• � Ie7X -`: 10 Applic nt Name �] Fv2-t K/ 1 . (L. ' K, Street Address 11 (S L U t4i Cr' 11 Zip! 'I .7-04i City Seoki Ad State w A• Phone (mac I ) C l JI (p, Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information DEPARTMENT APPROVALS This is not a Permit Application Type (Standard unless (Indicated approvals required in either"release"or"release with conditions" otherwise indicated) space prior to permit issuance.) Fast Track Early Start Release Release w/cond 1 Hold 2 � Environmental Health ❑ Commercial; fl i Residential c.. , W.1101 College ❑ New Construction; ❑ Bldg alteration/addition r Room 200 Additional structure; • APPLICATION# � L( Conditions/Comments: Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot wld; ❑ 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: El Utilities: N.811 Jefferson Conditions/Comments: Other: ❑ Plan Exam Fire Prey. Conditions/Comments: ci ❑ Project Representative Telephone ca Agencies Performing Special Inspection: c 1. U O V c`4 Ry F- 2. h O c 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold GRAPH SHEET:Draw your lawn area on this sheet io scale,1 p =1'or 1"=10'.Show valve location. c m v Show trees,etc.Use templates to position heads on finished drawing. -n f /■■ ■ aM/■■■ Filr/1 1■■■ ■■■ 1151■■■■■ ■M■■ . . /\ :,;irgiummummm i m 6 .■•1=.= - ■M4/.. - .■ � ■■.■M - .■. ■a •■ - ■■■■■I■��_■■�•■=i ii 61 O_ ,■■•/ ■ ..■■a.■ N ■ ■.■M.■ 1...a.. ■■ ■■■•■ ■■ ■a.■MM■■■■// 11/11 ■■■■■■■■■ /1 ■■■.•■■■ 1111■■■ 1111■■■ MM ■■■ ONE 4•■■..■M ■■.1111.1■.■■M■■. ■■.■■N3.■■■■•■■■:■■■.■.■ ■:•••a:$ M■IU•■MM.■ ..o ,- mum mum um NOSSIgggn•UU••MM■■: /■■■■•4M•M■•■a■■:. ■■M.■•■•u■M■M•■■. 4/■ .■•a■ ■■$■■•MM4■a■•■■■:•MM - .. „ RRN■■.■N■1•■.■a■4■M■■••■N.■'N■■■M.M■■N•.•.■""m"••■:■N•a■•■■•4.■M■■•.■■ o x¢;::., ••••u.: • ::::_ • ::•::::■••■N■•..■■::::••/1■�M/■:�1111: .N.1Q:a"" 11 1111 r s � 1111•• auu4=.■ :i u:a•..u.N.$: �■i::•M444N::i: i■M■13 a1■.. ■.■3a■3■■Ui/. gtt ::••: :••:.:::3■:•■.:■■■q pME:• •• a:::::.U...■• .:::M■: :■MEN NME:•:�•�•••:•■•:: •Mua•4::a..M■•.■.4.M4■■•.::::■■. a.$.= ■44■=■.g_.=:=.141:: . ■1N.•••1N::33 a ■■■■ �1 ■ .■■ mmmmmi■■MM4■46■1.. ■■ ■ M■ ■ ■ ■ .... MM NIMIMM/S■ M$� C■a1 ■. u1••u$.:........:11u116 u� 11112111 111111:"1111:3•■■$■■:::� d. ;, :a�a■M, 1N N ■ VMM■■M 3� O ; ■ �■■v N■■ Two■ ■•■�■•■r r .■ �■■ ���l++!�!! ■� N . ■a•i.N:: =:3a$ ••••U■• : MM�a3::::::■■:Na::•.•:■.M$:3IN:� :�.•:::: ..'•" << a. ;lac 11N ■■ 1111 ■ 1:%11. 11 ■1511 1113■■ 111111:®: 811.111111114111111111:1111 d ; o 4' 4 O 15 •■■ ■■■■■M■. � 1N■:1M■•1:• ■:..■•■ ■■:3.■:..■■ ..1.■.■•1■ : ■. ■■.■. ■ ■.■.a4a ■ r 1111:: UU....U.....Ui..•uu.ii..: :�:3::::::::::3: : ..::1:333:3:•:••::•• N o e, Y 1515 ■■..■■1:.:•■:N: : .■...■_:/..:�uu.....a••1.�M........�:■■■■.....a3■3:■.:� ■ M■■•■■■ ■NN M■■N• •■MM/ ■ ■■•a•■■■■//N■M/■ ■■M■MM■M■a • MOM . . • .C1.Nmummy.■■ ■ M•••■■:=3.■P B•.�•■.11.■■•=•■.•O■■■.Q:■i•:YMa:�•���i:�%1111:1:r:■■ n`i�. ::0./1M 115_1 11 1151 M•/■ 1111 mmo 3 . .1�... .... .uu.1■u:u:• .. aaai•■: :1a:1i■uaaalaaaa 1111:1 tat ■maAaa a^. ::114.■■/U�.■■■■a11•••:u1$su••■it mi■■■.■■.i1 •3.■••■•mma■•uNM•.■� ..■ •:••iuis ::.y 1 ::: ■a■■aa:.. U•••••i