1986, 07-02 Permit App: 00011946 Garage0SSSt.o968
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)
/i/F'S
Department UseOnly
ii3S. Comm
2 Project Address (not Mailing Atld ees) G tl Name Space Zip
F -/cp/ g,r/e :a
2/�
3 City/Community
t1,,Re<Av/dr',e cc
State
GUFF.
Subdivision/Plat Name
19fl-K ?U) - Ivt ievt4 1W'6 -,oke ?
4 Assessor Parcel No.
09 l S2- _O4 Owl
I
Lot
q
/
Block
a + + 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
?n'
(L S-1 i
(FOS -2 I3' Rear
27
Census Tract
Module No.
Initials
16 Architect Firm Name - Street Address
T^ N 5 /lin AAmolirri El �1 ssac /�7Fs ( N-/7_loti 6,Z— s,,tr per,
Zip
City /J/ //
State
Phone -/ /
74
Contact Person -
,T//N /24,7, /9
Phone If different than above
( )
Contractor Firm NameStreet
//
♦JJ14-.
f7nn �1 /�.P,75, —�>C/ %J
Address
� �/)� 64 1 -2:) -
Zip Gty
990 7 EST, s re,itr���
State
I �� ,
Phone
1 ) 9:2</--/33"
—Coonnta/ct/Person / �/
17.11 A/ (!('1/1 YI -
No. /7 q
(not(
l�('X)K \ . A4,-q,-,(�.-(A
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
Busl ass Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (YIN)
Other (Y/N)
I SEPA Exempt (Y/N)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
0 Other
0-vrb7v6
14 Describe Work
I -fX acLC. r1XrgaE
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Additional Information
n
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit Issuance.)
❑ Commercial;
❑ New Construction;
❑ Additional structure;
070?
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
Release
Release w/cond 1
Hold 2
WIA.1..././-!..
omnstIM
Conditions/ Comments•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone•
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
O road improvements
Conditions/Comments
0
Utilities:
N. 811 Jefferson
Conditions/ Comments•
Other:
0
Plan Exam
Fire Prev.
Conditions /Comments•
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
I
COOK BROTHERS CONTRACTING
Route 2 Box 853 B
OTIS ORCHARDS. WA 99027
(509) 924-1557
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JOB C 4 - �
SHEET NO E' // ,0 �/ � 41/2/E, n
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701454 204 Arable VoraEeSJmc Townsend. Kau 01470