Loading...
1984, 03-27 Permit App: 84A-2646 AdditionBUILDING 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) ,J4 (first) (m/) �/1 /F / /`O in Ev �/ • Department Use Only Ras Comm 2 Project Address (not CCMailing Address cr Road Name Space Zip E -'73-,9-1 H4r ,,c) E- //, SpoIe4Af, u).A ?Fara 3 City/Community 9 z) Kid e^ C State «!F. Subdivision/ Plat nnName r/.1 Jdr K KOii-c/ / ST 4;F/ 4 Assessor Parcel No ) es,t,. -04--21-1 Lot Block / ♦ ♦ r DEPARTMENT USE ONLY * * 5 Sic Code Zone Act. 0 Zone Py, sus Project No. 6 Dwell 0 1 No. of Buildings Sq. Ft./Acre Z3 X 1lD APS Depth 731• Frontage I Id 7 Set Back -Front 241 to" (L S-1 (R)S- 111b" Rear Census Tract - Module No. Initials - 16 Architect Firm Name Street Address Zip City State Phone ( 1 Contact Person Phone if different than above 4 Contractor Firm Name Street Address -s Zip City I State Phone ( ) Contact Person License No. Phone If different than above 8 Owner/Agent (if different than 01 above) S,8 441 E . Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) `IeS Other (Y/N) I SEPA Exempt (Y/N) /©S 1E5 Date 15 Type Work .Bldg 0 Fire 0 MH - 0 Demo ❑ryew ($ Addl Alter 0 Replace 0 Move 0 Other 14 Descri Work/ // x�---- 9 544a-4� ri2O/KdNl r.4.Yk. - a— St4ari 10 Applicant[f/dime KO lit ex 1. 4,E. ,/ Street Address A �. >,-s—?-,/ d ,,k�XW P (/ 11 Zip aya City �' JPUK.A-„ f State� � J W,A Phone (J279 ) 9.ad -/G3o Lender. q A./ Street Address Zlp City State Phone ( 1 Contact Person Phone if different than above ( ) Additional Information Application Type (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required In either "release" or "release with conditions" space prior to permit issuance.) Environmental Health W. 1101 College Room 200 ❑ Commercial; ❑ New Construction; ❑ Additional structure; APPLICATION # S154 0 -2 -SZ - 0 2 SZ- ❑ Residential ❑ Bldg alteration/addition Release Release w/cond 1 Hold 2 ., SKyLErs Conditions /Comments • VPlanning/Zoning: ❑ fLommerclal; Cert. of Exemption; 0 Frontage( N. 721 Jefferson of Setbacks; '❑ lot w/d; ❑ lot size; 0 use/zone; O CU, variance, zone change; shoreline; 0 fence; ❑ th r Conditions/Comments: n ��r �, 1� 1aat�d z y/Ars. (FILE AVE -/S-8L/) 3/ttl 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 z 4 17. E ftsr. . SE: PT IC -7741 tz-• 24 r-- - tic r e.- rrr /1 A 1 4 1--- F I-- F '1"1