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1984, 07-25 Permit App: 00001436 Residence BUILDING PERMIT APPLICATION WORKSHEETI 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 Z (last) (first) (m) Department Use Only CG 1,-...-1 Res. Comm 2 Project Address(not Mailing Add as)or Road Name Space Zip 4. P'( dJi Q M 11--`�Stat� ~ Subdivision/ Name 5.5')-t,5.5')-t,3 City munity ` j, A ke,t 4 Asseesorprcel No. Lot .A., Block Red d ,e M 0,-1- & /^ J -2-•i-5.4 ,\l-5 I - 0111 / (I (/ * * . DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone / Project No. 5F IV 6 Dwell ft No.of Buildings Sq.Ft./Acre Depth i r Frontage 1 I -2-e01 o 2-1 7 Set Bads-�t Y I(L)S-1 1 (R)S-2 I Rear Census Tract I Module No. Initials tt r J 0 N * 16 Architect Firm Name Street Address 19-A7f,'y 41 I1'c- I /4. / vi., A, j Zip CityState Phone q c b S1.L. )ca ( ) 91e-1-5v6 Contact Person Phone If different than above ( ) Contractor Firm Name Street Address Zip City I State Phone ( ) Contact Person License No. Phone if different than above i '. Z44-. P1"NDC. 1 20; Cc) ( ) 8 Owner/Agent(if Different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(YIN) Date 15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work 10 Applicant Name Street Address 11 Zip City State Phone ( ) * * • Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 1\ '1 . F_ (-7 ( S ? k -77.� G Det. e7o PecK - ,1 • DEPARTMENT APPROVALS • This is nota Permit Application Type (Standard unless (Indicated approvals required in either"release"or"release with conditions" otherwise indicated) space prior to permit issuance.) ❑ Fast Track ❑ Early Start Release Release w/coed 1 Hold 2 ❑ Environmental Health ❑ Commercial; ❑ Residential W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; APPLICATION# Conditions/Comments: CI Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; ❑ Other Conditions/Comments: Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain; �g—'..1:51 N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: El Other: ❑ Plan Exam � 1r-1�I Fire Prev. Conditions/Comments: �( a C Project Representative Telephone 0. Agencies Performing Special Inspection: o 1. E - E 2 rn o • c 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold 1 ,. , . . - ,,.. :At .................................... • Mg ...•••........................:........ . 1 .. ,,,."-"° .4...................... . 1 ,1X • Z. v I 1, 0 t . '..q : b . .14 / ; °I 60-labit, pr.4./r4.1dst" , le, 1 c 1 { I r• 4 -or- --NO . 011 .: / ,/rf..44e 111,-; Ftem Gr-44._ ,i , I r•-14.I. .. / ti\ . l'• / ,- Ii - .., / F ' 1-/' Ir•-1 . — t1/4\ - ... taa Z ---/ .....- hCa'144 fr',10Mfe.1—f 1.44 ?......wk.. 4 t —.....z '.r....„...............................„ '''''.".. "."'"..."'•••....„........L"- ., ".....,....................... -•------_ t . . .rive" ,