Loading...
1984, 11-06 Permit App: 00003230 MHw 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) Use ly 1Departmant _ (2)011Res. Comm 2 Project Address (not Mali {tddr .) a Road Name Space Zip /F1102_ • nee 3 ty Communitn / ... Cil ' State (//c/�� • S ivisiun/Plat Nam d... i t-- / � -C d�a - iso .2_,Lo, d a Block * * * DEPARTMENT USE ONLY * 5 Sic Code Zone Act. If Zone RN 11 Project No 3.256 6 Dwell f/ No. of Buildings / Sq Ft./Acre Depth '/026 Frontage &C 7 Set S&P-Front�� (L S-1 (R) 9 f Rear�� I`� Census Trect I Module No. II Initials X00 m . 16 Architect Firm Name I Street Address _Zip City State Phone ( ) Contact Person Phone If different then above ( ) Firm NI/tractor Firm Name Street Address iisa 4' F. /� 726 Cit qpm -1 Ir State `� Phone r .'0Z,? Cont son License No. 4) 7 Phone if different than above 8 Ow /Agent (if different than #1 above) Business Address 9 Zip City State Phone 1 1 12 Review Required Plan Check (Y/N) 40 Other (Y/N) SEPA Exempt (YIN) Date 15 Type Work jBIdg ❑ Fire 0 MH 0 Demo 0 New ❑ Add/Alter 0 Replace ❑ Move 0 Other 14 Describe6 Work p' �x ac ___, - - \_Jac/ / 10 Applicant Name �J Street Address 11 Zip City State Phone l 1 Lender Street Address Zip City State Phone 1 1 Contact Person Phone 11 different than above 1 1 Additional information 47 Application Type (Standard unless otherwise indicated) Fast Track Early Start J DEPARTMENT APPROVALS This is nota Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) Environmental Health W. 1101 College Room 200 Conditions/Comments- Planning/Zoning: onditions/Comments ❑ Commercial; New Construction; Additional structure; APPLICATION# A ID 9i0 ❑ Residential ❑ Bldg alteration/addition Release Release w/cond 1 Hold 2 i 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 0 new access/approach; 0 fence; O road improvements Conditions/Comments Utilities: N.811 Jefferson Conditions/Comments Other: Plan Exam Fire Prev. Conditions /Comments 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 OIL) )l J. { /91124 c -_ Oi (AtQS,UJ4 9?027 1 , 1 j 1 1• ---1- +- �--' j 1 1 • -+ l -4 I r 3 L- fAfult- , i a T r� —. —; �-- r i + r I.