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1985, 09-06 Permit App: 00007284 SidingBUILDING 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 (last) f(first) (m) Department UsesMly l/�` ed- n�./,�t �� ,J(� avit R Comm 2 Protect Address (not ailing Address) a Road Name $ a1ao /4 Space , ' f zip p� `n�J q 4 3 Gty/Community . l-dA4., State /n /414 Subdivision/Plat Name SV.1 V 1 c -c- flc26S 4 Assessor No. taB5-Z/1( " _t`VS �i"� Lot `3 7 Bieck ,li - .. • + , DEPARTMENT USE ONLY * * * 5 Sic Cade Zone Act. # Zone 5rrz Project No. `120 6 Dwell # No. of Buildings Sq. Ft./Acre Depth Frontage 7 Set Back -Front I (L 'Rear (R)S-2 `Rear Census Tract Module No. Initials _1 s 16 Architect Firm Name 1 Street Address Zlp City State Phone ( 1 Contact Person Phone if different than above Contractor Fivn Name Street Address ZIP Gty d&04so9) Stateone 9aI/lG��Cafille0,1 ersono /- /'n,(� . License No.Phone iii/%YRc 3ytini If different than above 95IWC 8 Owner/Agent (if afferent than #1 above) Busl ess Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) 1 SEPA Exempt (Y/N) Date 15 Type Work 0 Bldg 0 Fire ❑ MH 0 Demo 0 New 0 Add/Alter 0 Replace 0 Move x1 Othe��� , n .!/ t , 14 Describe Work /J �Ztei9 cele�9, _c ...-.2._1(4.1lc� 10 Applicant Name o 4� Street Address 11 Zip City State Phone Lender Street Address Zip City State Phone ( 1 Contact Person Phone If different than above ( ) Additional Information IA pp fiA04/1 Fa, -, tG/ OO t I , 5o =162 Soo c To - co m coa U N l' - N co LL DEPARTMENT APPROVALS o • • Application Type (Standard unless otherwise Indicated) Fast Track Early Start 1 nis is nota rermli :--- - •• - (Indicated approvals required In either "release" or "release with conditions" • space prior to permit issuance.) Release Release w/cond 1 Hold 2 • Environmental Health 0 Commercial; 0 Residential W. 1101 College 0 New Construction; 0 Bldg alterationladditlon • Room 200 0 Additional structure; ' - APPLICATION # - - - Conditions /Comments• Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; ❑ Other Conditions/Comments: Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N.811 Jefferson 0 drainage ❑ 0 fence; new access/approach; ❑ road improvements Conditions/Comments- • Utilities: N.811 Jefferson Conditions/Comments. • Other: Plan Exam Fire Prev. Conditions /Comments ' Information ❑ Project Representative Telephone Agencies Performing Special Inspection: 1 2 ' 3 1 Indicate above or attach condltlons relative to final as built approval 2 - Indicate above or attach reasons for hold