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1985, 01-31 Permit App: 00004082 AddtionBUILDING PERMIT APPLICATION WORKSHEET • 1.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) Use Only !Department �% 1 ©`1 4/�( ��? / 71e-(�s. Comm 2 Project Address (not Mailing Address) or Road Name Space Zip Al ,'-1,-. 5 , //4 /Z c/ 3 City/Community State lf/a s lr . Subdivision/ Plat Name 'F'1,. C -Imo{ 0 um o c°040 v 4 Assessor Parcel No. 07512 — 1 11 Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zone Project No. 6 Dwell 8 . No. of Buildings 3 Sq. Ft./Acre Depth t 21.1 Frontage 9 5 i 7 Set Back -Front .14A-1 0 (L)S-1 (R)S 2 - 1 Rear Census Tract Module No. Initials , 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 6// f3 8 C ( ) vYi 12 Review Required Plan Check (Y/N) Other (Y/N) SEPA Exempt (Y/N) Date 15 Type Work Bldg 0 Fire ❑ MH 0 Demo ❑ New Add/Alter ❑ Replace 0 Move ❑ Other 14 Describe Work ,RTD i 1 oN fio 1A1 ✓i'(�VO )/010e1 ht .&--� —oto ibe0/P e 10 Applicant NameStreet i,&ve /�// /-11 oh Address IlU$ 5 a y Rd, 11 Zip 0/LfAek-6. City 1_6.. Xc,_ State ‘•�/a s 4 . Phone (5-C ?' s"s" — 6 7 s— z, Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information I 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 ❑ Commercial; ❑ New Construction; ❑ Additional structure; ❑ Residential ❑ Bldg alteration/addition APPLICATION # Release Release w/cond 1 Hold 2 Conditions/Comments• Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ 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• Utilities: N. 811 Jefferson Conditions/Comments• Other: Information 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