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1985, 01-30 Permit App: 00004053 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 Name 46e4, -KreF) (m) Department Use Only 3/4✓E/e , Fbs. Comm I 2 Project Address (not Mailing Address) or. Road Name Space Zip S 3902— ,i/.2 -Z , ”0476:. 3 City/Community S�'c�:4- State 4 Subdivision/Plat Name IC,7-/.S CXfr 9 M' /4c/we . 4 Assessor Parcel No. Lot Block 14/ * * * DEPARTMENT USE ONLY 5 Sic Code Zone Act. # Zone Project No. ()5 6 Dwell # I No. of Buildings i Sq. Ft./Acre Depth IzS Frontage 93 7 Set Back -Front 1 I ff (L S-1 3o l (R)S-2 !Rear Zg' 4 , Census Tract I Module No. Initials n^ ..J'V1 Y Y 1 16 Arch tect Firm Name bk'A-T % 711/41 C -e .4 t i C-5 n✓' Street Address N, c?"l�•o4-. Di v / sfcrnf Zip 9'9zCi. City SPc-vC.,_ State 'j'v,.4- Phone (Svt) r27-C;z.c2 Contact Person LT -&---Fr --i4'l dv L- Phone if different than above ( ) Contractor Firm Name life 8/4 (v-Ny. ai 1c . Street Address 7 9,/7 4V6 -1.f s rii Zip 9 90/ co city/v, �'ee s State f ,4. Phone Sod) `/� �_���� ,'contact Person /3eLiCe `WA -;_r-5 License No. .eC,el4 e. --1-- /7 Yc7g Phone if different than above (s??") Z7-2.2 / 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) SEPA Exempt (Y/N) Date 15 Type Work ;PC Bldg ❑ Fire E MH ❑ Demo New ❑ Add/Alter E Replace ❑ Move ❑ Other 14 Describe Work 10 Applicant Name Street Address 11 Zip City State Phone ( ) Lender G�r3Si/:Nc>r v/'r%r Z' -5/4 Street Ad ess G. t '�� 7Y2— Zip c7i(r 3 Cit _ — State rev 1. Phone ( 5-6)9 y .1-.5---- 729/ Contact Person L y ni n/ Phone if different than above ( ) Additional information 'tn' - 13 V 6 Pel- ; 491 DEPARTMENT APPROVALS 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold Application This is not a Permit • Type (Standard unless otherwise indicated) Fast Track (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) • 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 ❑ Additional structure; APPLICATION # Conditions/Comments• .3•',—ice v • Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; 0 CU, variance, zone change; shoreline; 0 fence; 0 Other Conditions/Comments. / 11 Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence; ❑ road improvements % Conditions/Comments• r V//11 O/S Utilities: N.811 Jefferson Conditions/ Comments* -- • Other: • Plan Examrem Fire Prev. Conditions/Comments. _.......„ r4 i r oti__ Project Representative Telephone Agencies Performing Special Inspection: 1 ` Informati 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold N w' 5l GAR A ve S. 34oL p1//_/551.) Lc); / 1.5'e c 4 /H,L,corng .3/Y AlaN E/V(::,Nee,' sehtte id 3o r_