1985, 06-26 Permit App: 00006107 Patio Roof A
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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 Owner's Name (last) (first) (m) Only
Ldrei ceQ C?eo rge_ Mr-Z.
Ree. 1 Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
�
i �� / Va.(te v L / y y4N-160
3 City/Community State / Subdivision/Plat Name
.52P 61 i a1/1 e (/La
4 Parcel No. Lot Block
/5-5-9-5 a S-) 7 * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone4-5Project No. l`6
IC
6 Dwell k No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front (L)S-1 (R)S-2 Rear Census Tract Module No. I
94'9—
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
FC 6 e r+ P d ttej /3 9e 3 ' Spd (ce_
Zip CIty , State Phone
Contact Person License No. Phone if different than above
Pie Lara3 2-EC. 45�9qf ) 9!..^2-8-- `0/&
8 Owner/Agent(if different than 41 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) I SEPA Exempt(Y/N) Date
15 Type Work ❑ Bldg ❑ MH ❑ New
Replace ❑ Other
❑ Fire E Demo ❑ Add/Alter E Move
14 Describe Work � -i
gee bee d(GCpp prI-l'o roe( %.,-:;4-k vi oiii e
10 �AAggplicant NameStreet Address
14 beg'i rt'e' 7� /390 3 - Spr 7--c c_
11 Zip City ., State Phone
c�Q.2-/4, S"ee 4/ti met ( ) 9"..."-S-- 9,1t 4,
* Lender Street Address *
Nati e:
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
111
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.) r
Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
El Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION#
Conditions/Comments:
O Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
. N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
El Plan Exam
Fire Prey.
Conditions/Comments:
a
�❑ Project Representative Telephone
ca Agencies Performing Special Inspection:
1.
Y O
U —R (O
2.
y O
.. c
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold