1985, 08-27 Permit App: 00007099 SidingBUILDING 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)
,q'�A(m) JoepartrTyeecniY
fJLL l / [ Fba ✓/
Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
/�
99a7
3 City/Community
State
all
Subdivision/Plat N,(ame Ctii ' /
4 Assessor Parcel No.
f % , /�
C 7.�
Lot Block
/
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #C
Zone
45
Project No.
70QC1
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Bade -Front
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Copntr r Firm Nam .�
/fc/Z-df37�����_,,1
Street Address ss
1?oto(
Gty
State
I
Phone
Atad on
s
4/ , bilr �/
License No.
ii4eUncl,8�34/6n?(
PhoneIf different than above
( ) 5.
8 Owner/Ag (if different than CO -Move)
Business
Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA Exempt
(Y/N)
Date
15 Type Work ❑ Bldg
0 Fire
❑ MH
❑ Demo
❑ New
0 Add/Alter
0 Replace
0 Move
70 Other
1
%/J� �j�
14 Describe Work D__:"?..1,
/ / ta,_/1!,e_e--------
10 Applicant Name U
�J
Street
Address
11 Zip
City
State
' Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
DEPARTMENT APPROVALS
■
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
i nis is nota 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 ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/Comments.
•
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments.
•
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
•
Plan Exam
Fire Prev.
Conditions /Comments
` Information ❑
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