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1984, 08-13 Permit App: 00001746 Addition . 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) // i7(6 1 Owner's Name /� (last) (first) (m) Department Only 2©/�-Gly ----7-/41 L L . J F . Comm 2 Project Address(not Mailing Address)or Road Name Space Zip 3. /3o/ 6,24/ivEoe3173/ 9 e:o& 3 City/Community State Subdivision/Plat Name CSPoft40E - Gt>rqz5/1 uti/ ()ERS/7 L-7 pe-Ac 4 Assessor Parcel No. Lot Block c;615-y� — c,1/o / LI -a- 3 I (O a.0 * * * DEPARTMENT USE ONLY * * * r 5 Sic Code r Zone Act.# Zone 17 Project No. y( 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage I Z (5vi t Sb t 7 Set Back-Front (L)S-1 (R)S-2 < Rear Census Tract Module No. I ' I tic l �>I— * 16 Architect Firm Name Street Address * Zip City State Phone ( ) 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 ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan eck(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date 15 Type Work Bldg ❑ MH ❑ N ❑ Replace ❑ Other ❑ Fire 10Demo Add/Alter ❑ Move 14 Describe Work ADD t7-I s c ,? -stv Ax: Y P-kysc,,E 10 Applicant Name' Street Address `� 2 or�� S. 13 c�' v4.//vis rr, 11 Zip City State Phone 99d ay ,c1249,-c--4-4) . Ga>�/� (S"oy) ' .d� -8 23 0 * . * Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information t 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 w/cond 1 Hold 2 v-w Environmental Health ❑ Commercial; Residential 0"/3"gi W.1101 College ❑ New Construction; Bldg alteration/addition /Aptikir Room 200 ❑ Additional structure; APPLICATION# Conditions/Comments: Planning/Zoning: 0 Commercial; ❑ Cert.of Exemption; 0 Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; 0 fence; ❑ Other Conditions/Comments: Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence; ❑ road improvements Conditions/Comments: Utilities: N.811 Jefferson Conditions/Comments: Other: Plan Exam Fire Prey. Conditions/Comments: • ci ❑ els Project Representative Telephone cu 0. Agencies Performing Special Inspection: cc g 1. - f0 �p i- E 2. y 0 co C LL 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold