1985, 06-21 Permit App: 00006049 Dental Lab in 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)
Department Use Only
\
\ Qk-k-L 1. kl F}
mss. ' Comm
2 Project Address (not Melling Address) a Road Name Space - Zip
id aa1% LAv-211 2b 99a/a
3 City/Community
5pc, wa lE
I State
WA
Subdivision/ Plat Name
t.J8.57 ✓Adley .]nN
4 Assessor Parcel No.
0-7S441 — o3a3
Lot
9
Block
a
t * + DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act. #
Zone
Project No
6 Dwell#
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2 j Rear
{I
Census Tract
Module No.
Initials
16 Architect Firm Name Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( 1
Contractor Firm Name
Street Address
Zip
City
State
Phone
1 1
Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zlp
City
State
Phone
( )
12 - Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (YIN)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
1 mPcP '4 �$nTAti 'P, u3 til -1 (&) PSS) bEMC
10 Applicant Name II Street Address
11 Zip
City
State
Phone
1 )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
U sE AT oaJ 2 -b Rti C P'a - 6C
rase.< c it7 X a /%r 10,e/ O�hic-7 o -ng feleirc�ci a, —C - 6- �- 8
ifie,
c-4 oorrh 6 , /9ss
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
t
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑
111
Environmental Health ❑ Commercial;
W. 1101 College ❑ New Construction;
Room 200 ❑ Additional structure' J��J
APPLICATION # 6 g-(4
❑ Residential
❑ Bldg alteration/addition
Conditions/Comments.
Planning/Zoning: ❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
Conditions/Com men
❑ Other
/3' e 1
Irbs
�zl
T.D.Jet^ae .u9- nrry
Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments-
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
Release
Release
w/cond 1
Hold 2
rith
Conditions/Comments.
Planning/Zoning: ❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
Conditions/Com men
❑ Other
/3' e 1
Irbs
�zl
T.D.Jet^ae .u9- nrry
Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments-
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