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1985, 09-05 Permit App: 00007259 SidingBUILDING PERMIT APPLICATION WORKSHEET PLEASE 'RINT 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 , (m)1 Departt tpgOnly ks,(last)/(fi}rst) (.0 ,D/.) �. ✓7 Comm 2 Project Address (not Mailing Adcr Road Name Space Zip S (32C alAd- VA qv'© 6 3 City/Community StateSubdivision/Plat Wg Name f'?C.,N Dezp, iNtom, t7 jJ 4 Assessor Parcel N 3,Z�4 ( —1 I CD -2-` '�1 Lot Block * ,t* DEPARTMENT USE ONLY ,t ,t* 5 Sic Code Zone Act. # Zone Project No. � � 9 6 Dwell # No. of Buildings Sq. Ft./Acre Depth Frontage 7 Set Back -Front 1(L)S-1 (R)S-2 1 Rear Census Tract Module No. Initials " 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name - - ailit4a,r-e_.:a- Street Address / 1- .316 �rZIP Zip -t City iR//te State Alt Phone ( /09 ) Vt.- g6 ,1/1, Contact son /�/� / i Y' 1 /j License No. '/�Q vQ, ivi.�VP/ I,664,cl zL�/ ,/j�% r C(l/1i(!/ Phone If different than above�o� ( ).0//6 8 Owner/Agent (if ffferent than #1 above Business Address 9 Zip City State Phone ( ) 12 Review Required Pian Check (YIN) Other (Y/N) I SEPA Exempt (Y/N) Date 15 Type Work ❑ 0 Bldg Fire 0 MH 0 Demo ❑ New 0 Add/Alter ❑ Replace 0 Move ;:fe Other i ( - 14 Describe Work _i C ��y-/ �� D�%� 'r� `V'//�v�,--� Applicant Name Street Street Address 11 Zip City State Phone ( ) Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information Vii,c4a17,e-ii? R f i- 1, 00 iiiii,mi.71-747: , 75.; 00 41, 50= 7.50 DEPARTMENT APPROVALS ❑❑ 1 Application Type (Standard unless otherwise indicated) Fast Track Early Start 1 nis is nota rermlt 4• -R (Indicated approvals required in either "release" or "release with conditions" ^ space prior to permit issuance.) Release Release w/cond 1 Hold 2 Environmental Health ❑ Commercial; ❑ Residential W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; APPLICATION # Conditions/ Comments • Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot wld; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/ Comments• Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N. 811 Jefferson ❑ drainage ❑ new ❑ fence; access/approach; ❑ road improvements Conditions/Comments. Utilities: N. 811 Jefferson Conditions/Comments. • Other: • Plan Exam Fire Prev. Conditions/Comments• iInformation ❑ 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