1985, 04-08 Permit App: 00004836 Relocate ResidenceBUILDING 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 (last) (first) (m)
�"\/ C ��ki�i %_ iii%/ % l� y fr
Department Only
Fbs.
Comm
2 Project Address (not Mailing Address) ar Road Name ( Space Zip
N.315 ( //f0. ,/, 96 3)
3 City/Community
'',erct d Cc (E:-'
State
WC ,
Subdiv�isii n/Plat Name
l/e r-0
4 Assessor Parcel No. ,
/ 3s 4 - -2 //
Lot
X
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. 8
Zone
�
No. 425
6 Dwell #
1
No. of Buildings
1
Sq. Ft./Acre
Depth _ t
1 SO
Frontage
'Q P)
7 Set Back -Front
4b
(L i i
(R)S-2
Rear
Census Tract
Module No.
Initials
j
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City I
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
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
E Add/Alter
❑ Replace
I/Move
❑ Other
14 Describe Work
eL..oC4PV . ?c kOEilv(e=
10 App ''cant dame �j
rI(2 'i (, 3Pwtc-1,-',-
Street Address
ET, /.. / ,J�r-i#uc.-fl;l!e�
11 ip 7
97'16,
City (---
4:7 o ,
State
1:/t,c :
Phone
( ) 9a 6 - 27,-,2S
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
MU1o) e 4A, E. 1 Q.0l g '���--: Pro WR-{ q -3& 3 �S- rir
DEPARTMENT APPROVALS
U
Y
~
y
LL
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
1 IIlb IS rj a ret trill
(Indicated approvals required in either "release" or "release with conditions"
issuance.)
space prior to permit
' lelease
Release
w/cond 1
Hold 2
Environmental Health ❑/Commercial; ❑ Residential
W. 1101 College P New Construction; ❑ Bldg alteration/addition
Room 200 C Additional structure; �J
APPL ATION # d tr) ,..73
Conditions/Comments•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
0 lot wld; 0 lot size; 0 use/zone;
N. 721 Jefferson 0 Setbacks;
0 CU, variance, zone change; shoreline; 0 fence;
0 Other
.
Conditions/Comments:
.
Y
` Engineers: 0 Commercial; C R idential; 0 Flood Plain;
N. 811 Jefferson 0 drainage new access/approach; 0 fence;
0 road improvements
Conditions/Comments: f,N141V '
'
Utilities:
N. 811 Jefferson
Conditions/Comments:
Other:
Plan Exam 418)10$
Fire Prev.
c)z-Y
Conditions/Comments•
a
'
: 1
ro
' "
Project Representative Telephone
a
c
Agencies Performing Special Inspection:
1,
O
cs E
2
O
E
3
fJ
1
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
GENERAL COMPUTATION SHEET
FORM 1015
NAME OF COMPANY
united engineers a constructors inc
Ck //i
SUBJECT P4 17 /35'1.3 42 fa /
81,C01
0
Sok U ft 4061 west 150 ft-,
er the Al. ;10 of Ne
E or c
Lo
1000 9afr
70,2 _ _
07,
CI, 2
J.O. NO.
SHE ET NO. OF.
DATE
COMP. BY CK'O BY..
1'
,2/5
gr_C-1-.2 3Y
111,00'
Conklin
C. 1