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1984, 04-18 Permit App: 84A-3523 Shop BUILDING 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 �y s (last) /h (fl st) ) �DepartmentJJeeOnly (�(��//'/ / Ras. V/ Comm 2 Project Address(not Mailing Addrets)a'Roa me Space Zip ffo4402, PVrf1[ �.1c.Q 992-. 0 G 3 City/Community J State�� Subdivision/Plat Name S (Cc,PI CL C l4 , C UAc.K-`5 6c4 13 4 Assessor Parcel No. Lot Block 175414 7 _05-0Y 4 Z * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage l Z ' �8` 7 Set Back-Front 75 I I(L)S-1 t (R)S$, i L Rear Census Tract Module No. niti sq * 16 Architect Firm Name `JTL ✓ Street Address CC * Zip 92® /(D CltY ) 0 Cr Vi State d S Phon(�,1.) 2 3 2. 0 contact Person // Phone if different than above ( ) Contractor FinName Street Address ^ ) () SU2 /0(-102_ Sp i 5 iuy' Zip City, State Phone 99Z©G p© ftc� vi2 LC)Q Sy (92 ) 2- 3 Z 0 Contact Person License No. Phone If different than above ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip CityState Phone ( ) 12 Review Required Plan Check(YIN) Other(Y/N) I SEPA Exempt(Y/N) Date 15 Type Work (Bldg ❑ MH _/6 ,New ❑ Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work 10 p cant Name S O Street Address t // I an�v [ 6"iC9 Y02 / v s i/, l 11 Z�p� City pQ ha 11 ►, CState((Dos ' Phonel2 � 3) 2 ` LO * G`j JeJI s Lender Street Address - Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 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/cond 1 Hold 2 Environmental Health ❑ Commercial; da'Residential W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 Additional structure; APPLICATION# Conditions/Comments: Planning/Zoning: 0 Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; 0 lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; ❑ Other Conditions/Comments: ❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: Other: ❑ Plan Exam Fire Prey. Conditions/Comments: a c❑ Project Representative Telephone aAgencies Performing Special Inspection: :;"2g 1. 0 U '- N E 2. 17) o c 3. 1 indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold 1 -a' ,y I;; g' -78' t. -t. S S LA . Lc.-r 4 1. Jc '—t4--0504-