1985, 08-07 Permit App: 00006740 DuplexI%
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 past)) (first) (m)
- � .� � LP , rn l . O •
Department Only
Pas.
Comm
2 Project Address (not Mailing Address) u Road Name Space Zip
E / 0103 a- o.s GU oR A- q9;-06
3 City/Community -
ka iJ
State
O .
Subdivisionf
th tss
Plat Name
' o Aa 4t"d; 7 oX,�
Aaaeaa pn
/1 4 sj Pa(rcel No. n
1 �`XJO 1l Ox Or D96 4 ? � -Joi7
Lot
i 1-Z .
Block
/
* * * DEPARTMENT USE ONLY
5 Sic Code
Zone Act. 0
Zdne ''( �r71
I �Ar/
Project No. (07 vo
6 Dwell0
No of Buildings
Sq. Ft./Acre
Depth i
Frontage
gyp'
7 Set Back -Front
SDI
(L S-1
1
15
(R)S-2 1 Rear
5 (
Census Tract
Module No.
Initials
JON m
16 Architect Firm Name Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( )
Contractor Firm Name
..c.0 rn
Street Address
Zip
City
Slate
Phone
Contact Person
License No. 0/
Phone 11 different than above
8 Owner/Agent (If different than 01 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (VIN)
Oth r (V/N)
SEPA Exempt (VIN)
Date
15 Type Work jZ. Bldg
❑ Fire
0 MH
0 Derno
A New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work ,/� '^ / //
Neu) CONC7-2(!<ri ()A) ('J/iP_ �� !)U y` Id;» CLt���
10 Applicant Name S rest Address ../
La)OL f Li ioc1 el). S. 7/7 po,`.cles ,fid
11 Zip
99.1%
City
`cpour-Le_}
State
Uf0
Phone
(c9 ) 9 ah' -ac-9?
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
( )
Additional Information
01F_ 817.()( 2-
U 8 L- 94,6 y ug=X
&k/.. ' 300 )1 7 --
PECK : 1&o X z
PECK
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
Conditions/Comments
❑ Commercial;
❑ New Construction;
O Additional structure;
APPLICATION #
❑ Residential
O Bldg alteration/addition
S7s-o roo
Release
Release
w/cond 1
Hold 2
i .. ii
fiOi 0.1 cV4
Planning/Zoning:
N. 721 Jefferson
Conditions/Comments
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone:
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
0
Engineers:
N.811 Jefferson
nditiipns/Co ments:
❑ Commercial; 0 Residential; 0 Flood Plain;
7-20-
0
❑ drainage 0 new access/approach; 0 fence;
road impr. veme is )91-4.41.3
Ali
/0" If i irergrast
fw,. . e,
Utilities:
N.811 Jefferso
Conditions/Co men s••
Other:
0
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
a70
or -
0 '.
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