1985, 04-11 Permit App: 00004897 Residence , -. 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)
4
1 Owner's Name (last) (first) (m) DepartmeyseOnly
AA,/D 7 L) f.,i/�lOr1.— Fes. Comm
2 Proj ress(not Mailing Address)) Road Name Space Zip
1 At4 L _a._10-1 ii /
3 City/Community State Subdivision/Plat Name
4I No. Lot Block
3.5�Y ♦_' M 0 411- 3 * * * DEPARTMENT USE ONLY * * *
5 Sic Code if Zone Act.9 Zone ` Project No.
SFR 491
6 Dwell N No.of Buildings Sq.Ft./Acre Depth ) 4 Frontage
1 / _ e3 - fir '
7 Set Bads-Front ) (L)S-1 v (R`'^ t Rear ; Census Tract Module No. Initials
2�1 . C ' 0 25 l i
* *
16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
A/012.117 4., t ka,+l - PO, €X 14/Z`3:S
Zip CityState Phone
` iZt44 SP„,�- cJ sh ( 3°d ) 5Z.�-agtiCf
Contact Person License No. Phone different than above
iii ilo,z rh II - 2/3b7- ( )
8 OwnerlAa�eft(different than 91 above) 9 Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(YIN) Date
15 Type Work C 'Bldg ❑ MH $ New 0 Replace 0 Other
0 Fire 0 Demo 0 Add/Alter 0 Move
14 Describe Work
resigenree, ( tacc-e (2,N/de#.-
1 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 I nformratiion
1113 = 39coli
1/)
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
•
Release
Release w/cond 1
Hold 2
APPLICATION #
Conditions/Comments•
i
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:
N. 811 Jefferson
Conditions/Comments•
❑ Commercial;
❑ drainage
❑ road improvements
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
O 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
; -!...'!+:4;7,4t . i I ._.• ''"*.,1,,,;.iy '.0 • -P. .4.i' 'I' '
, ',... • 'Ilk?. 41 . , • e•1 ' '; .,...ii**.; , h471, ,•,•,i" ,•:4'.'''';04. .„
•••'`1;•. AT., .i..',,:l., . , ..',' • 1., wi. I. IW..4r,), ;
'1, ' 1.'.-14.,' t..1- ., IP' "`1!•• . ',, ..1 .,,, s. t :` ,:•,;r ,
. • .1. , L ... 1, "...1 • i..., 1•.y.1 l, bi, 4:. : .. .-, 4 i '' , ' ' ,•.•• , • , ' j
i . j • Eil ' i,:, -. i tl'itg•,..:44V.• ' .1:.•Nf. '. 'i • • ':.,.., 1,i •••',"/
. t
• , i .• • • •4k1 II • i .„.,,, d ..„,,, ,.4 $.,,,,,4 1 . ..„--• •• .. 1 .''. 1 f 1. .1% •
', , :7 ''•' .;' ,cbl i . 1 ., • ; „ irity.; Izt.',,t , v l';.": i . P.,.,,,C:il eie; ".• r.-.
' , . r .4 .1t`.!: ' '.,,,' •,' -;_`..V.' •- -'1•,''.! f.,., iti'• '• '!I;1
71' , •• 1 • . ‘..'''•ii,..4•11,,, , '• 31":!.F.“i' "-i..---'ir '" •,• . :t1.14,-:44 : A
.144 '''.1. 1. **'.t..*, ' ;- '4.° i :4.;, ', 1 .i.P':'. ei ''f.":4 '.f. '' . 14'..
..':1;•,:,.) •• 'I. 4'. . • .':,... .- :., :%,;;.i, 4.q .:,IN 31 JI 4app • a.)
l'f1 :r• 1 ' k1 •.t
l''.Yr!';.:;•'!'
'• . 4....7.' ' • t,k:ii.; ,,i'-7 .. ''''. •••'‘..j'ai
1.:1144. '„ ' i • t• ',.,Otr-.11
• r. • 4 '• '%.;
i • '
• • ' . 14 i; .4.: .' ." ",).''' : II'VAlt
' . : ' ' •. . . ''' VI .'".* l' , ii-
-,ki6Lk:::1,t.4,
" • c. • ' • 1. '••• 1 :} 4 ' ,..,,i, ;; , ,
10'
•
i.•,•4
Wm
faL
•
v/
5
1
4
/n.e.ma r
I./4e 74 04.Ja .1 '7' A I a Air I g
Z 4) 40.4.14 L..0
7e..6.o?7(