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1985, 07-02 Permit App: 00006200 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) ti * * 1 Owner's Name (last) (first) (m) Department U Only / / . __ !�1�/ Fps. ' Comm 2 Project Address not Mailing Address) . Road Name Space Zip ;1d,�.� 92-e& / /2/ > 3 Ci y/ .mmunityt ,,�-- ate , . /� �� et Subdivision /Plat Name / /11/44/ 55 i O n/ It i /IS / S % A 0p To 4 • • -,..r Parcel No. O t 6-z1j7' — ogo z Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zone A ' Project No. / L� : 6 Dwell # / No. of Buildings / Sq. Ft. /Acre Depth 110'65 Frontage eV 7 Set Back -Front I (L)S -1 (R)S -2 !Rear Census Tract 1 Module No. Initials 6`,4-ea 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address Zip City j 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 ❑ Bldg ❑ Fire ❑ MH ❑ Demo ❑ New ❑ Add /Alter ❑ Replace ❑ Move Other 14 Describe Work fMMrnIG Poo L G) 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 Application Type (Standard unless otherwise indicated) Fast Track Early Start Environmental Health W. 1101 College Room 200 DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) Conditions /Comments• ❑ Commercial; ❑ New Construction; ❑ Additional structure; APPLICATION # 405 '/! L� ❑ Residential ❑ Bldg alteration /addition Release Release w /cond 1 Hold 2 a� r Planning /Zoning: ❑ Commercial; N. 721 Jefferson ❑ Setbacks; Conditions / Comments ❑ Cert. of Exemption; ❑ lot w /d; ❑ lot size; ❑ Frontage; ❑ use /zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Engineers: ❑ Commercial; ❑ Residential; N. 811 Jefferson ❑ drainage ❑ new access /approach; ❑ road improvements Conditions /Comments• ❑ Flood Plain; ❑ fence; 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 1 44. N *as fe , • 7.%•`-' 9- 1 0 i : ) i ) I i • \ ./.. i I • 4 ; / t: • • i I i 4 I q I •,( I :. , 'A-r, _ e. 1 ./1 C;PS 4p •It ^ i C-4•94/1 I 410, ,?.-.... ; - ... . , --f. -:.., - [1 4p,,,; : 7., ::-.., . L-ii c. . , L -4 . 1/ , A... '? ! 1 ' I 1 : A 4! i-7 / ■ i .,) 4 • "4.. . ' rr •---<-. • 2 l‘Iggtig9a(