1985, 04-29 MH VoidBUILDING 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 Name (first) (m) Department UsgOnly
A(last) /
Comm
C. I
�4 re1 7 �4 ir
2 Project Address (((-ail1g Address) or Road Name Space Zip
S die) 4— l.• f!r")..Az• ri19:1%/o._
3 City/Community
5%� 4 n F
State
/Or? < A
Subdivision/Plat Name
Ula As %9 Si.a 15 li—
e Assessor Parcel No.
, % 7 /
2353 -11-7C/
Lot
/
Block
/ I * * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone f '
Project No.
6 Dwell #
1
No. of Buildings
/
Sq. Ft./Acre
Depth
/ C
Frontage
`SOP
7 Set Back-Front(L
25
S-1
15
(R)S-2
37
Rear
29
Census Tract
Module No.
Initials
(24,1,e)
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
( 1
Contact Person
License No.
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
Pr. -MN
❑ Demo
I'New
'_l Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work /
21/ X56 Hob i Je /Ictite
10 Applicant Name
.1s.�D! C. e e,'ff 41.'
Str ddress
L
1 ?C �o/
11 Zip /
19,.1:) Z_--.
City
eit/4.,L,
StatePhone
///a-
To
"pet •55 0:40, fJio+�
( ) 4/48- 139
Lender f
t"+1
Street Address
Zip rpty
3[+
ate
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
v j V
) 1
RE-Ifiues7:D RE-Ftwo Raw AcAttii
11!;'
0li LL /VC I CYO xeinc. -TE- % 7&cT
„ f l LJD)
G.1 -10)e'/ C5G9 �'�
E C E 1 V
a
c
0.
u)
U
l6
t
h
LL
♦f
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
1 nis is nota rermit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
Environmental Health ❑ Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION #
Conditions/Comments •
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; El lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions /Comments •
21
Engineers: ❑ Commercial; D Residential; ❑ Flood Plain;
N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑r4. • 6 improvements
Co diti omments Illi •_• : _ .' �. i�..�� . 412•-11,—,_ =
��1`L.,
r �
Utilities:
N. 811 Jefferson
Conditions/Comments-
•
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments*
IInformation ❑
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
•
' i L
1
,` ` r• ''''.•t. �-+fes-- air
.4.,
•
i1/4®�
A
,
-I
_..4
I b' �N
41
1 I
y
I { I
,
4?
3 '
1
I
b4.
! i
0.
jam/+
t ii
10,
/�'�'___'''_� "� ��
i
(
1
I I : � +
- Fr .
r}
'
----
S,
iv
•
FT
f2
I
I I
i
!{ l i
l i i l i j l
i
! i i
! t
! VFX .
—
i !
i I
!
! I�
r
i!;
--
_
! I
I
f(
l 1 I l f l
l'O
!
! I
!
_s
1�
';'t;
l l l=
j( l l i
t -- -
i` it?I
1 i �
•
• ?► 1 i3
i
! i 1
i I
j i �r
______ -
-, L.-