1985, 07-01 Permit App: 00006324 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 NaLmee/j (last) /' (first) (m)
WY A< .ST "1-- -� -$SOC 1']7PS"_ r% t c .
Department Uep Only
Comm
2 Project Address (not Mailing Address) v Road NameSpace Zip
• S 23// i-�AHrcR ,•-' C.r--. .., �. �i2vc, _
3 City/Community
ort ,C .L-, r,
State
tO, a .
Subdivision/Plat
T A...i1L%cce
Name
/ 6.1C%.-e:a9,cr /r,s& c/
4 Assessor Parcel No.
POi.7OFi17J'/I-7009
Lot
iZ
Block
/-
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.*
Zone Sre
Project No. '
6 Dwell II
r
No. of Buildings
I •
Sq Ft./Acre
De
/01.73
Frontage
•So'
7 Set Back -Front
30
(L5-1
Is
(R)S-2
38
Rear
—
Census Tract Module No.
Initials
G
16 Architect Firm Name '/���
.7 /7 d' --Cr,g
Street
Address
c1 CrQn, ci Arc
Zip
-CO � I v
city
�/J
%.-5'9L (Oi N.- /
State
�O CIiG.
Phone j 15 ) L23 — C /O >7 .
.7 ic'
Contact Person
Phone If different than above
( )
Contractor Firm Name�/j
(.��, .e J/ d /7
Sac i'�. f. �iae.
Stree
address y�;
l/. 4/cyl5
Zip
99 -2---/C,7
Gty
Sia LEen -•
State
cv -e.:-...
Phone
(;Za9) 92-V- (910
Contact Person
E',,,,,/4;//E',,,,,/',
License Na.
ax SAS-z/s r'
Phoneif different than above
( )
8 Owner/Agent Of different than 01 above)
�i i7L_
Business
Address
9 Zip
'City
State
Phone
12 Review Required
Plan Check (Y/N)
Other (YIN)
I SEPA Exempt
(YIN)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
cc New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work p/� / � l J� // //
S;y2/e - A=..n: /r .Ij coe/fi.ia9 - IU/-- A//-3che-ci-Qavge:
//��
10 Applicant Nammee-
L22 .,..r. /tom �I v1,0 C _2-2-,„/
Street
Address�o'
O, f Aii esz
11 Zip City
967z_iV SP.,kzhe
State
Cl.) 2..
Phone
°9) 92.4_ a9c1
Lendernd
)c1 An Aila Scv✓/c P3, tHc,
/CAll
Street Address
/�
X570 A. Nr9ohate eel
Zip
992-0 E
City
Cin ,c -aft a
State
ce12 .
Phone So 9
( 12-2.—iE-6-0
Contact Person
1 Jr -r a ✓�0 n S o h.
Phone if different than above
( )
Additional Information
il_—, �
./ `11
/tic' 81-7 = MF 18V = GAR 1I I 1111- 1 I J 11�
\1o' tc,c = 2r In r --qF l V U
LI t—
�y 817=ur'
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application Type
(Standard unless
otherwise indicated)
This Is nota Permit
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
•
•
Fast Track
Early Start
Release
Release
w/cond 1
.
Hold 2
Environmental Health ❑ Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
APPLICATION f! I -5-___ 6 76 V
Conditions/Comments / i iL✓ ii :iii/��/�'
, r
SIT iri
�
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments'
Engineers: ❑ Commercial; 0 Residential;
0 Flood Plain -
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence; L
J�
❑ road Improvements d ' / /
Conditions/Comments' - ' �jr --14/
•
Utilities: - -
N. 811 Jefferson
Conditions/ Comments•
•
Other:
•
Plan Exam
`i a
Fire Prev.
Conditions/Comments _
Project Representative Telephone
Agencies Performing Special Inspection:
1
I Informati
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
/O0
OT "79-
�/t/2 dC&
00
�1�cl%L7n t /1T ~LI
h!
I
R —
1NPie
(01/1 c
1
_Co
•B/
M
d
1
m 4
'00
A
4t
Lir
s
d
-7i.,[4 net
0/
06
4-11 Pvc gigs_
#sr. D -3°34
SDR. sf. -
)44t
7-t ,4C
I2 -
ea
2 SC/ 1!Y E I hr /11/%1[/