1985, 08-07 Permit App: 0006742 DuplexBUILDING 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 r _/ (/�],(� (last) (first) (m)
ti t ��'�CL �-lV
Department Use Only
R .s.
Comm
2 Project Address (not Mailing Address) a Road Name Space Zip
E /07/! 4- 13 02P 99.o6
3 City/Community
A e
I State
Loa
Subdivision/ Plat Name n / /
m A S; v4D P� to( oe �iyao ��i do t�
Parcel No
4 A5513530Parcel No
Ii i)0Rv0+1 of 0954/3 — /019
Lot
3 4 4
Block
'.
• * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. /I
Zone
`I lT�
Project Notri/2
(�-
6 Dwell a
2
No. of Buildings
1
Sq. Ft./Acre
Depth
123
Frontage
`101
I7 Set 3p t (L I
(R)S-2 1
��
Rear
Census Tract
1 Module No.
Initials
�� ,
16 Architect Firm Name I Street Address
Zip
City
State
Phone
Contac Person
Phone If different than above
Contractor Firm Name
(Dirvt 4
Street Address
Zip
City
i
State
Phone
1 )
Contact Person
License No.
;uoLL-l- 324aS
Phoneif different than above
( )
8 Owner/Agent (if different than IR above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (YIN)
I SEPA Exempt (YIN)
Date
15 Type Work X. Bldg
0 Fire
0 MH
0 Demo
X New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Wlrk
Man Cma4rR,jr Ti Dip r�n� ,S�o2y �7i.i/�w
o//e/
10 Ape' I nt Name
01'd e0,
Street Addres
S. 71 9.rles �d
11 Zip
99e6
City
40ok4-,ve.
State
°Le
Phone
(3 9aop- a6-92__
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone if different than above
Additional information
mr sic `A -2-
z06
06= £3o X z
6fl,: 0., no Z
I 2 Cie-- = (60 xZ
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;
O New Construction;
O Additional structure;
APPLICATION # cr
❑ Residential
O Bldg alteration/addition
Conditions/Comments: /e,11-440-1. /r/ 47 le o` 24.
Release
Release
w/cond 1
Hold 2
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone.
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments.
0
Engineers:
N. 811 Jefferson
❑ Commercial;
D drainage
road improvem
>nditio s/Co manly'
�i
�..• .Mirror
Utilities:
N. 811 Jefferson
❑ Residential;
❑ new access/approach;
=.ra. yP3
❑ Flood Plain ^
❑ fence;
Con tions/Comments
/tAa ine—G
Other:
4-
•
0
Plan Exam
Fire Prev.
Conditions /Com men is•
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relativeto final as built approval
2 Indicate above or attach reasons for hold