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1985, 04-20 Permit App: 00005201 Residence• • BUILDING 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 ly �p Fbs. Comm CIHAPCCi 9 sz -, t.,-"--)`— Cil.R le' MA- fa '~Zip 2 Project Address (not Mailing Address) ar Road ams Space Lbr 1 I'6.1 AI (deur' 3-j-=,UZ s. LORe-riA 3 City/Community sPatr,....-e_ St to i ailA Subdivision/Plat Name j✓4 Ai( Lc., -)...(e- 3-d- 4 Assessor Parcel No. 3 s4 r ^ ib' Lot / Block / tv * * * DEPARTMENT USE ONLY ,t ,t ,t el 5 Sic Code Zone Act. # Zone 1 ` Project No. r C 6 Dwell k 1 No. of Buildings 1 Sq. Ft./Acre Depth 135' Frontage gS' . 7 Set Bads -Front (L)S-1 (R)S-2 Rear Census Tract Module No. n s 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) CoeStractor Firm Name A Pc o (a_s-��2�c-r, �►.l reet Address 13 121 Slcy Vi Seki Zip q 2l(p City S State LOA Phone (so4) ,12: sZ y 1 - Contact Contact Person MYr'— Crt AP ...J License No. CN A A C t 1 La Phone if different than above ( ) 8 Owner/Agent (if different than M1 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 c j 1 1k4,A ,..G., Fire E MH ❑ Demo et New ❑ Add/Alter ❑ Replace 0 Move 0 Other 14 Describe Work (:7 t C-B">t r -'41 1 4-c 10 Applicant ne L uA Nu d• Street Address ss rO ?( (f 61-k-AV^- 11 ZipCity iCT)OYo S( State Phone6 ) Lender �jki Street Address kiASWilcr�rrv� MO v , S'Av Zip City K, -t0 5./A( StatePhonePo ) Contact Per n y,.. Phone If different than above ( ) Additional Information 7 - . II _ b.. 1 a DEPARTMENT APPROVALS d • • Application Type (Standard unless otherwise indicated) Fast Track Early Start This is not a Permit (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 0 Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/ Comments• �8 II Engineers:111/47 En ineers: ❑ Commercial; ❑ R idential; ❑ Flood Plain; N. 811 Jefferson CIdrainage Nnew CIfence; d access/approach; ❑ road improvements Conditions/Comments. /Nib e72 17 Utilities: N. 811 Jefferson Conditions/Comments. Other: • Plan Exam Fire Prey. Conditions /Comments: Information ❑I 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