1985, 08-07 Permit App: 00006743 DuplexBUILDING PERMIT APPLICATION WORKSHEET
421
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Pfease return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) partmen s6 Only
/n/ Ir
/ /�
Wei -.�d CO' Fbs. .� Comm
2 Project Address (not Mailing Address) cr Road Name
£. J o%' g ' 0 2 I
Space Zip
0R A 99zo4
3 Clty/Community
D f(AiVed
StateyS'yu�bdivision/Plat
(.uQ
Name f� /
//!/ss% dA) 7)1J e ZRd /9Q/0', , oV
4 r Parcel No.
Lot
4 6
Block
( /
r * + DEPARTMENT USE ONLY * * *
�1 p * 0� Di 9�
c�. D/3I tiO/9
5 Sic Code
Zone Act. 0 -
Zona 1—E ft
Project No. 101 lS
r
6 Dwell 0
No. of Buildings
Sq. Ft./Acre
Depth
/23
Frontage
9a
7 Set Back -Front IIL)S7
(R)S-2 (Rear
Census Tract
Module No.
Initial
16 Architect Firm Name Street Address
Zip
City -
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
c5ii-C»4–e
Street Address
Zip
Clty
Slate
Phone
( )
Contact Person
License No
Phone If different than above
8 Owner/Agent (if different than Ml above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (V/N)
Other (Y/N) I SEPA Exempt (YIN)
Date
15 Type Work [ Bldg
❑ Fire
❑ MH
❑ Demo
A New
❑ Add/Alter
❑ Replace
0 Move
❑ Other
14 Describe Work
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10 Applicant ������� �' rei-,'/� ki
�/
11 Zip
/
City
.SAO0,e%I,e&_)
State
W9
Phone
( 4) aor -a 5-9-2-
9<vLe99,2
nder -
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
Additional Information
mF= el( Xv
rig= S-40 y>
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I D" -ca= ((acy-i v
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•
O Commercial;
❑ New Construction;
O Additional structure;
APPLICATION # (I
❑ Residential
❑ Bldg alteration/addition
-ogoa ��d�°��
>&, �/-
Release
Release
w/cond 1
Hold 2
Viirfr'd ea
Jo
Planning/Zoning:
N. 721 Jefferson
❑ 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
Conditions/Comments
Engineers:
N.811 Jefferson
❑ Commercial;
❑ drainage
road improvements
❑ Residential;
❑ new access/approach;
FAtl - 923
❑ Flood Plain:
❑ fence;
Con'ition- ommentQ_ ]_.... _i - � ���� ' /' c a' 41
/.% .,y/. . . - . - , _ �// s de/l i.3 ' � �%
%� .., � /i. -. _ �.�� i Ze�� �. 1. - if '..air
I i se 4. 'An � /.pd �JP�no���r�')! / ii/ JrN. 811 Jefferso, '
Utilities. ' . - ,t t..o_.h. Gti!/ i
it /.1ParriCalrAlllir --" ., .-e-74-.0_4-4/ .1-c;
Other:
El
Plan Exam
Fire Prev.
Condltions/Comments
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indkate above or attach reasons for hold
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