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1985, 05-14 Permit App: 00005397 GarageBUILDING 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) (first) (m) Department se Only 1 Owner's Name (last) frl r. /a / � wCO/j rr:! I Res. I Comm !0 Zip 2 Project Address (not Mailing Address) ar Road Name Space C, //r03 O/1 kic q44 3 City/Community .-`�a,tavw 6, /m- State (., ,1 Subdivision/ Plat Name &11711-7 - 011 v 4 Assessor Parcel No. /los 3 - 72 Z 3 Lot f lG I Block * * + DEPARTMENT USE ONLY 5 Sic Code Zone Act. 0 Zone ^¢s Project No. 63q7 ' 6 Dwell0 I No. of Buildings 2- `Sq. Ft./Acre Depth /35.7. Frontage P-5 7 Set Back -Front I (L)S-15 (R)S-2 I RearCensus Tract Module No. Initials 16 Architect Firmm> / A I Street Address Zip qty State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Street Address Zip qty State Phone ( ) Contact Person License No. Phone If different than above ( ) 8 Owne Agent (if different than 01 above) 4/ C''' q`S #i q co e Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) 1 SEPA Exempt (YIN) Date 15 Type Work Er ❑ -Bldg Fire ❑ MH 0 Demo C3- ew 0 Add/Alter ❑ Replace 0 Move ❑ Other 14 Describer I AC lied C9�A PA G 10 9.00,licant Name /'C/ C hG r ti P /- > e ' ftt>c o (_� Street Address U60.3 4 fr Z 992p©N Cp o^4 r% State r / P Phone 507) ?.0 / 2 OC c. Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information Application Type (Standard unless otherwise indicated) Fast Track Early Start 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 ❑ Commercial; ❑ New Construction; ❑ Additional structure; ❑ Residential ❑ Bldg alteration/addition Release Release JAw/cond 1 Hold 2 1 n 1' S-/3-7-5 APPLICATION # Conditions/ Comments• Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments• Engineers: ❑ Commercial; ❑ Residential; N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ road improvements Conditions/Comments• ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions/Comments. Other: Information Plan Exam Fire Prev. Conditions/Comments• Project Representative Agencies Performing Special Inspection: 1 Telephone 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold g pa - E- le See+ GP4- I 4 II 1-3141,‘ A/° 710 Sccie-