1984, 09-04 Permit App: 00002098 RampOrS
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 e I ),A (ilrst) (ml
l N 4-0 7 i/f
Department Use Only % r)tftj
Rae.IjComm
lv `'
2 Prol Address (not Mallin dress) cr Road Name Space Zip
A/007 3-ks Via/
3 City/Community t
S��elNo.
State
Subdivision/Plat Name
6PPon.TUn)to
�`l rt.F�
4tux/
Assessor
1
��
Lot 18
Block3
a a ♦ DEPARTMENT USE ONLY * *
5 Sic Code
Zone Acta
Zone
Project No.
6 Dwell N1
No. of Buildingssl
1
Sq. Ft./Acre
Depth i
Fro aget fi
7 Set Back -Front (L)S-1(R)
-)/( (1— (c�o 1 -
S-2
(+ Rearcensus
4 -'-
Tract
Module No.
Initials
J00
m •
16 Architect Firm Name Street Address
--ION 1<, )4IeR._ CEIS no le—
Zip
City
S,po lib e
State
WA/
Phone
1 ) 335 90a7
Contact Person
Phone If different than above
( )
Con or Firm Name
Street
ddr ytreie //e n
Zip
9902 (9---
City
spck ,e
State
019%
Phone
1 ) 06 -70/ 2..
ract Pers�ny �/ License No
e.4/ I t /ecoM/ r ,22 3 -o! S o if e,° 3Tc/MO"
Phone if different than above
8 Owner/Agent (if different than 41 abo e)
Business
Address
9 Zip
City
State
Phone
1 )
12 Review Required
Plan Check (Y/N)
Other (Y/N) 1 SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
0 Fire
0 MH
0 Demo
❑ flaw
EP Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
u.'he e / Cha,( Paan
10 Applicant Name
Street Address
11 Zip
City
State
Phone
1 )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Additional Information
i
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
This is nota Permit
Application Type
(Standard unless
otherwise Indicated)
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
•
•
Fast Track
Early Start
-
Release
Release
w/cond 1
Hold 2
Environmental Health ❑ Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
i
I`
Foley
APPLICATION # -
Conditions/Comments
Planning/Zoning: ❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions / Comments•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road improvements
Conditions / Com men is•
•
Utilities:
N.811 Jefferson
Conditions/Comments
Other:
•
Plan Exam
Fire Prev.
Conditions / Comments
Project Representative Telephone
Agencies Performing Special Inspection:
1
Informatil
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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