1984, 08-27 Permit App: 00001955 Relocate Residence on Basement„
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UN ERSTAND
(Please return thls original and your building plans to tho Department of Building and Safety)
1 Owner'a Name - •b • • (lest) Hirst) (11) Q.Tartment the Only .. .
_ . . ..(......-514'r—rrj � e.:75...15e.( -d+ .�'^ lT? � - RV' I Comm
/-y�.(r �/
2 Project Address (not Maiiiingg Address) er Road Name /Space l °.01
S 1 2-E- -
07677/ cbO o Rd • .'• :via%.fooD »4 1
3 City/Community • - -
5FOi'/JeAr
StateSubdivision/Plat
W�'
Name ,
'7 Ca' rLI-�.,NG I�'R nIs t r p- P -:
4 A.—or Panto& No.
KO 51-z - ,o j�
Lot
._3:4 1
Block
f w w DEPARTMENT USE ONLY ♦ ♦ f `S
, .. .
6' Sic Oboe
Zone Ana
Zone A s r^ Project No. a./ 5 '
let
, , 6 Dwell a 1
No. of Buildings
I .Y.
Sq. Ft./Ave
Depth , ,
13B - 3a
Frontage `• ,
7 9 :7 ,
I:794:7'
7 Set Back -Front (US -1 L
of Z .
(R)S-2 ( Hear
Census Tract _
- `
.Module No ,;
Initials
J
N Ir, • , ,
* i6 Architect F in Name -Street Address
Zip
Qty
Slate
_
Phone
Contact Person
Phone If different than above
Contractor Firm Name
n
(- eam . eC,A4,Ml/P--..:
//VC'
Street
( v1�,50/4'
Address
: 44/046.e.--1-fr.
Zip .-
c
Qty
'eSPO
State
j- w�.
Phone
(5cl) I ` 87 309
ac)
N736
A.'Contact Person -
F� R y ca eig
License No.
'a. -0(47 -5 -dr-
i� �T
Phone it different than above
i )
6 Owner/ ent (If different than at above)
Bust
ess Address .%
.
g Zip _
City
State. __ -
Phone
12'Review Required _..'•-
Plan Check(VIN)
Oth r(Y/1),.'_.
�.
SEPA Exempt
(VIN) —-
Date. .
15 Type Work ❑, Bldg
' ❑ - Fire -
❑ MH -
0 -Demo
❑: New
Add/Alter""
..
❑ Replace
/Y
0 Other
,_”
14 Describe Work - -
'f-�C
.tCt.4rC- - srR�ecn_oS&. -:- rn
0Jo13--LAj
. ¥ rlcDc6 ;
10 Applicant Name .'
( —At C 6 I&) E � oar5
CC ,tIC
Street
Address
) Sw (40 4M/i-/S`►
11 Zip ,Qty 1
.,'9ZC%.�. __I.Stoo ' ...' '
`
State
Phone
) ¢� 0.9 __
Lender
14/
1 //// _ _
..
Street Address
._ ._, .Phone `.....
Zip '
City '. _..
State
_.. _ "
Contact Person -
-• :''T__ ... ._.. . _ _ . _ .. _
Phone i/ different than above ' 3
( )
Additional Information
'ISPEcnot3._._WM healleitkit p 6'( 49 octt'-(
SP4� N
U8 -:-• -4 x'. -{-I --z-, oAi- oiP-- RD us :-Is.- (:o CA O ori 'moo 5-PPwAr'E r {,-'
41
to uSE Is . LACP(r :: <� ; C.,o j a ._ '2w Wfr1'' ` '.: . - .
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.)'
it
Environmental Health ❑/Commetcial - 0 Residential
W. 1101 College 5 New Construction; ❑ Bldg alteration/addition
Room 200 0 Additionalstiucture;--•=-I' -- -- - '
r1/4r10 �v tihert"
APPLICATION eConditions ... bis — _ v/ 1 - f a —t /01C i4-2A-/1-(itP/trj
Release
Release • -.
w/ d/1 'Hold 2�-
WIP
� ra-T ir�
Planning/Zoning:
N.121 Jefferson ..
ConditionslComments:
❑ Commercial;. ❑ Cert. of Exemption; 0 Frontage;'
- ❑.. Setbacks; ..'.;.-"❑ lot w/d; ..❑ lot size; -: 0 use/zone;
❑ CU, variance, zone change; shoreline; , - 0 fence; -
Engineers:
•N. 811 Jefferson
Condltions/Comments:±
❑ Commercial; y 0 Resldential; 0 Flood Plain;
❑ drainage . 0 new access/approach; - 0 fence;.
❑ road improvements" '
-A • – - vt,
Utilllies:
',N. 811 Jefferson
Condltions /Comments:
;.l
Other:
1.
Ian Exam
ire Prev._....
! a' V gl.h•y
_ - ..
g''•o�% S`P
-• _
..�:
F
Conditions/Comments: -
•
e o
: `o
E
3 c
Project Representative - - Telephone
Agencies Performing Special Inspection:.
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
a
9p/fi 0,E137Y G ,WE
SEC T. /6 T2s /
J f , y9 V WM•
.4c,73.q /gff,M5
F7/1.5 r /� b/T/O.t/
?go pttSEfl. Plast4riEW L 1 &Ls
/97o
7.5o
97.cT /9T0
a.
H2O
' P.�aoERryL/,��
Ay
51Iicc(ANL .
G'-o"w�o�
c-977 1
111E.
•
dS-le44 D pf.t_N, 1 N{.