1984, 11-26 Permit App: 00003527 Duplex•
BUILDING PERMIT APPLICATION WORKSHEET / PS
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 / (Iaasst)���' (first) ' (m) Department Use Only
.���''
I Poe.
–±iti* r -,
Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
5. a os - ao 8 - 9 47 Co o',e.r 99a/
3 City/ mmunity
5PO,gainl6
State
w /4
Subdivision/Plat Name
SiLV F ..,• fhb's) T/D A/
4 Assessor Parcel No.
33s5L2— ono 2—
Lot
z
Block a : • DEPARTMENT USE ONLY * •• a
I
5 Sic Code
Zone Act. II
Zone Project No.
�.=L 352
6 Dwell!
2
No. of Buildings
• 1
Sq. Ft./Acre
Depth
I R-{- EG -
Frontage 1
674
7 Set Bads -Front
zYI
(L 5-1 I
10
(R)S-2 1
2E
Rear
—
Census Tract
Module No.
Initials
.I01 -1A11.
16 Architect Firm Name - Street Address 1
Zip
City
State
Phone
( )
Contact Person r '•
,ice.: .._
Phone if different than above
( )
Contractor�Fiirm Name •�yp-�p�[�"7,/y /�
i ,. � �"'
Street Addres //
. r 6 -113 / 5i �-(�L
,({
. y `n/c /�'�����-!r t ---"-U �`-7� /'" \
Zip
99a-1-�
Gty
�PoK- c4 -Nie_
State •
Phone
(SP? ) --9 L8 - 3 06,7
Contact Person
License No. ems
4',rN'
Phone if different than above
8 Owner/Agent (11 different than 01 above) -
- FM 5-- Y: SE I PP9
Busi ess Address
Zip^,ofCity
SI Q/C�/u c.
State,v7(t'3/
on (cog) 9-283°&7
12 Revvie/w Required
Plan Check (YIN)
Other (V/N) I SEPA Exempt (Y/N)
Date
15 Type Work ® Bldg -
0 Fire
0 MH
0 Demo
1Z5 New
0 Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
MC -12) coosT,2uCT) 0Al DUPI.X amu? Gfl4
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( I
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( I
Additional Information
Nkca- s)-rc 7GtzN n L LIVE
1
.MF_., -I � 075 XZ - I-1soe n Pint/ n.... I
Igo
_5171!Y.z- io311 —"
C1.--,L_IVL-;
6All = Z07Pix2 = ;744
uc-_16,
32o
DEPARTMENT APPROVALS
]
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
I Illi' Ib IIUl d rCI mit
(Indicated approvals required in either "release" or "release with conditions"
issuance.)
space prior to permit
Release
I
Release
w lcond 1 Hord 2
❑
Environmental Health ;, Commercial; [.7 Residential
W. 1101 College ❑ New Construction; ri Bldg alteration/addition
-
Room 200 ❑ Additional structure; (
APPLICATION # 7 L /'3-9 e
Conditions/Comments- ei �:,,e ' /
❑
Planning/Zoning: ❑ Commercial; E Cert. of Exemption; C Frontage;
❑ lotwld; ❑ lot size; ❑ use/zone;
N. 721 Jefferson ❑ Setbacks;
0 CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments:
❑
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain,
1101111
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence; Sr
0 road improvements/! v /�( �
Conditions/Comments- �
❑
Utilities:
N. 811 Jefferson
Conditions/ Comments:
•
Other:
❑
Plan Exam
11 27-s y
Fire Prev.
r
/` `fes
Conditions/Comments:
Project Representative Telephone
°❑
U
c
Agencies Performing Special Inspection:
1
a
tl ca
- E
2
5 0
a c
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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