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1984, 10-24 Permit App: 00003000 AdditionBUILDING 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) (m, 1 Owner's Name /%/y(l�/ash}/� (/first) (m) IpsparimentlOnly TRss. ✓p !,�/ V !//�/� �(,R .7— Comm 2 Protect //,/ (not flailing Address) a Road NP 0oAle 'Vacs Zi/ /d -O 3 City/ mm ItyState ,d 2#,ive Subdivision/Plat Name eir-ftaatt N cry 4 No. ,/_ Cal+ R Al ^ l J Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Cade Zone Act. 4 Zone {j �1�'� Project No. ._ss> 6 Dwell4 / No. of Buildings- I 2 I Sq. F1. /Acre 7&0000 Depth 2426' Frontage Iota' 7 Set Back -Front (L S7 3D (R)S-2 Rear —, _ (Ansus Tract Module No. Initials �Ww 16 Architect Firm Name I Street Address Zip City State Phone - ( ) - Contact Person Phone if different than above Contracjor Firm Name ael /OA)/t1-�— £-°7»Gt4s f Street ,e----/?a_) Zip ! ga D� City D / `_V,�`_ State ' M 14-241. V �R Phon(n , w r..J..71 ���!!!C% oat Penton o -u LI No-_ � / (�OLOrJC• i3 /N Phone If tlliferent than above ��y 49 7a— S Owner/Agent (if diff ant than 41 above) Busi ess Address 9 Zip City State Phone 12 Review Required Plan Check, (Y/N) Other (YIN) 1 SEPA Exempt (Y/N) Date 15 Type Work C✓Bldg - 0 Fire 0 MH 0 Demo 0 New Add/Alter 0 Replace 0 Move 0 Other 14 DescribeW rk e[/, 11 f,©n1 7 U res/deAree„ 9/11-49e ' // veva /ere° above r&5 . 10 Applicant Name Street Addr 11 Zip City State Phone ( ) Lender Street Address Zip P City State Phone Contact Person Phone if different than above 1 Additional Information Sts # aAlaACe6 S25# km' Application Type (Standard unless otherwise Indicated) Fast Track Early Start DEPARTMENT APPROVALS This is nota Permit (Indicated approvals required In either "release" or "release with conditions" space prior to permit issuance.) Environmental Health W. 1101 College Room 200 Conditions/Comments- 0 onditions/Comments- ❑ Commercial; ❑ New Construction; O Additional structure; O Residential O Bldg alteration/addition APi •• TION # 0* • • Release Release w/cond 1 Hold 2 nta 9� Planning/toning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson ❑isetbacks• 0 lot w/d; 0 lot size; ❑use/zone* CU', zone change; shoreline; 0 fence; N. 0 Othe Conditions/Comments TZa=otSe�J t'�c—'4rJ Nip 0 Engineers: 0 Commercial; N. 811 Jefferson 0 drainage 0 road Improvements Conditions/Comments ❑ Residential; ❑ new access/approach; ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions /Comments El Other: P F lan Exam Ire 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 , C \ 0 MINmun_ foe C.-.) S-roay i 443 i i I A r 1. I - L • . • • 4 " ... ..... ...;:i- c•-• 11.o.,.... : : , •, , ;. , :7! '<Ieq • i" /to' . • , •