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1986, 06-10 Permit App: 00011487 Deck Cover(THIS iSN'JTA PERMIT) BUILDING'PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) SHADED AREAS ARE FOR DEPARTMENTAL USE-- Project Number Owner's Name LAST FIRST MI t v D L2-- ©iy..1> L Project Address (Street Name & Number)Z p /1e9 E. Le 01.)O47A 47C. , 56K4,,/ G 7er.. 77 o Applicant Address / L. L uiv9 II/1S.z4 t. Lam& K PR^ City,,,_ Y Krtel—'0C. µA,/G State 14.1A- Zip 0,6 ? 7 .a..0 rtc L phone - - 1507 7...z7—y/1.2 Li - - - Business Phone 7 Q (ICI I/ % f � V J Contractor; Agent Add V ass City State Zip Phone I Contact License Number (Required) - Business Phone 1 Architect/Engineer c_5c LS-- Address - - City State Zip Phone -- ( ) Contact Business Phone l 1 Lender Address City State I Zip Phone Work. "r:..rh, .,» ..; y:- : .';;''-` �? `' - "OA CSVC.. "SubdivisIon/Flat `.•' ... G Ci r _, K, Res: , .. • Comm, Name Short Plat Number.'..p ' - :y1CW— FD°.‘T(0N .•- Assessor,Peicel Nuinbei;`F^:3'•;x; -,.T_ '_ . - - _ -, 'p _•' t•y`',;iyk^ .*`_-r•. - - : ass::.::►;°cra .•-.; .Lot - .. t 10 Block ..•._� ` ., (� Pi 'Plat Number — tPertInentFilumbers,°..;7 ;'s=..;_«" _ eN �.`• •'fin{y. "".^' ` 'Zone - Comp,'Plan"_". -' ' Census Tract ;Number of Dwelling Units�''?«J,"t.'y=y,C� = Number of Buildings •-• _ , c Lot Size (Sq. Ft./Acre)' a— —. .•.- - - r.._ -. Frontage Front Setback+,;k, U. -- •". `ty ,. Left Setback; ---.. :'. Right Setback --- .Rear.Setback. :. .s.. R/W Width: - "Additional Info rmetfon'--a si.n i:.. in..•¢.:.¢ n.+3,'.?.�' r"dN�.y.,., :..:'r,�: �at'•. :.. -. __ ~;y•.-.'A'.r .. cJCI :i S• ... .. F:BUILDING INFORMATION Square Footage.. 9:r=,i':.: f-!•: ''.;'::-'.y, . . .+„'.{:.;•d;ak`d` m,ttuars .:rs. .. ,` a;w{i•wn:�^".'LH.--:, a,4rK.ri°'.:• L'i�'`M.ti:.'l':-.r T�.:.4.i's�'�.3`' .. . . : .+'`� .. _-.. • ':t�,',ia."'..i'a.A.''cu#u.'T.n- sir n'. `. t.N'' ,:-'J "•:`°C'-'•"'. :^{'4 : �' .'r .' r ' ,pr - t .' ->,t - _ .. -. 1�t v ?�';�_'°.€i'•4t=2(".%:c;&'='r`'.�_;,'""xiC,'`i':3:: '•tom;: �`:, .. - _ _. .. ai.T>.-P::K:'-_yi�ta • e �'p�r�' 7:e .. :. �cr a:„, y'�i.' - . .. �F. .aC.'1'L'�a.4ti•- ,4Y Z".:..'YlS iti'CSia". ty,Y'„'.>.'r• .... ' �..�r - ... .. , r�.� G. `:.,._ £y'�;ya'St':} hs:k, v-(•[1',,I,i.�.`'h.i�3 D=usru;�S;'}t'1��>t..:<n ';r� i..:.;x. ..iy'�FLL>;-j"i-t St Siti.,aa:y;:A9::'✓<'ca'st»>+;,s:-,;:r,•.:a=.I -' .. .., .w..�.,..a: Number of Bedrooms - a.. `.t. •`.'i',,v4_`. ,_Y M'roup :Build) Tebh. ./•• nfleoh. Y - '°�:*:� ys exs Dae' *.;y;a, ' .. -....., . - _ "' Group 7 nI • DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my agent )o compile : id appll . Ion is and ,prrect. Signa Date , !` Approved Cond. Approval Hold Environmental Health Application M 1 /7/Oj)j / % ' Ai .i•�_ _ice W. 1101 College/ Room200 Planning/Zoning N. 721 Jefferson Engineers N.811 Jefferson Utilities N.811 Jefferson i . Plan Review/Fire Prevention N. 811 Jefferson •- -- - - - Other (SEPA/Crltical Material/etc.) Fast Track/Special Inspection Information Project Representative I Phone i Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent )o compile : id appll . Ion is and ,prrect. Signa Date I • i ! I I r ! 1 r i IL 'i jr I r...• , , 1 I , r . 1 , I . , • r ' , , • I r ' ; : . :', .,--I-- . 1 i • 1- I. r i . I , rr --1- t ' __ I . . - •1 I I , 1 i i ; • r • I I .1 • , i 1 1, , r i . , • I •, I • r I i I [ 1 • 1 I -• -t - t i- 1 I 1 , : 1 r • 1 i - I — i I : '1 ! r 1 ..] . • , -1'• r • ' i r i 1 • 1._ ! F iF i 1 ! I - -I: ' ! I - : 1 r . r : ' I . ! . t r .1 ' • I ! : ' , 1 1 I - I I ! : 1 1 I, ! • ! ' r a ! i ! L..... r.- 1 • i. I r 1 1- r I I I , • ., , , 1--- -r-- !, 1 I, •1 • 1- • I L__ .L . I , kI I I I ! I 1 ! 1i .1__ 1 , • , r ! i I, I 1, - 1 ' t V • 1 : ! , , ! . • T r ! ! 1 •. , . , . , ; . • I r ! , : r . . -, ., I. . . r ! , . ! , r . 1 , ! . • - • , • F I 1 I --. • =1, : F-_-F--- • r • I 7 . , - : t , I • I_ I , .... :, ! I . . I F. . I . . I 1 . !••, I, r 1 , ! _. , .. • . _._ ! : . r . : re r ! I I . . I , # .• 1 4 r— I , ! , 4 il I • .1,,.-_, , I I 1 i I F . . . I i • 1 , . • 1 I 1 , ! . _ , t 1 _ ,) I I . r ' , . . , _ I. c L:__. _ __ _.! ' • --; • • • i ' : ! r, •t- .,, I _ . .. • "k T. 1 - 1 I • _____ i • -'1 - --f , ._ -• t I. I • h.../ , , ----------------------- - i. , , . • . ., ,_, • " .. i 1 , I . . r r ! I . r . , , I , . . . , . r-4 ' ! i ' 1 - . , , , Show on Site Plan: Additional Information: Lot Dimensions Landscaping Existing Structures Drainage Plan Proposed Improvements Hydrants Structure Setbacks Topography - , Easements Lighting Septic System (s) Signage Water Lines Shorelines Sewer Lines Highwater Mark Fences, Wells Driveway(s) Right of Way Width(s) Names of • Fronting Street Flanking Street !.........n., I . . r r ! I . r . , , I , . . . , . r-4 ' ! i ' 1 - . , , , , . it , , r 4 .: .... ; . -C e :4= ! cu! t LI en CD 0 TO 07 CI . b.. ri ., t: . I . I . . . . . t . I . • , . , , 1., .., . . , \ ! , , Scale: Date: Date: Revisions. Attachments: _ 7 j