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1985, 05-15 Permit App: 00005803 Residence . y r , BUILDING PERMIT APPLICATION WORKSHEET �-o `• PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND L � (Please return this original and your building plans to the Department of Building and Safety) 1 Owner'srName (last) (first) (m) Department Slee Only �lV /Z- il-rb' /79:SCsG 7.,c,,c Fix. , Comm 2 Project Address(not Mailing Address)ar Road Name Space Zip .S".S / C9 // V ,X4,4--1-7 /Z C .' - 3 City/Community State Subdivision/Plat Name 4 Assessor Parcel No. „3„,001.. .._2 0. Lot Block C'. �i v k - 3 / * * * DEPARTMENT USE ONLY * * * 5 Slc Code Zone Act.4 Zone Project No. O 6 Dwell4 No.of Buildings Sq.Ft./Acre Depth Frontagy / / 130 /if 0 7 Set Back-Front, /,., I(L)S-1 (R)S-2 1 Rear Census Tract Module No. Initials (/,sr�J C</(4(.41 * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address -_ -- /.0 X S. 54 ne s-rs 0 r_ c l”c /. e / >X iv o e y- Zip CityI State Phone Contact Person License No. Phone if different than above A/« c5iii f 46,2/7 s-ty--s- — ,Y.-41 ( ) 8 Owner/Agent(if different than 41 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(Y/N) Date 15 Type Work ❑ Bldg ❑ MH jac,.New ❑ Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work �(a.LF 1=/fart'1 y , Fd,,.0 p-->e--e-e_ GG « .f l� Pit/i 10 Applicant Name J Street Address 11 Zip City State Phone ( ) * * Street Address Lender Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information , / j / � 1 A r _ d e A - ) ; 451" i MF — / '5 u' 11 t I� .2F -7- i f II r'!rrs 371E 4, F/c vesr 0AI1 �==C t V (ASE'= 57 , 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/cond 1 Hold 2 % " Environmental Health ❑ Commercial; ❑ Residential W.1101 College ❑ New Construction; ❑ Bldg alteration/additionEi. Room 200 ❑ Additional structure; APPLI ATION# U 69R--‘ Conditions/Comments: 4,L- Zie7 y/- �G�G�/ X- ❑ 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 PlainqIIIIIIIII % A N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road 'mprovement . / Conditions/Comments- i xx�i - i i .e.,‘-- , l� / 4 / ._ . =l >"��i v%E:rti: l' _i i�i��7 / _ice. �f. .dr Or ❑ Utilities:N.811 Jefferson Conditions/Comments: 1 Other: --- ❑ Plan Exam 1 Fire Prev. '� ��'•E Conditions/Comments: 03 C To - Project Representative Telephone ca Agencies Performing Special Inspection: -Ic 1. Y 0 0 -co tti i- t 2. h O l4 C 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold . � ' ' • • \ : • • . 4 .. 2 . .,- . - . . . . . „... , ,. . . ..,. 0 LO • • 0 i I \,,,,,K. 135.000 237. 211' I rf)t--: . • o yd.\A \ , A PA NO rib p_h • • NI\ R = 15.0 00./ • Oil t 0 , Ca*, i c, ert4 04( . „ , z),_,-,--" 44 v.144:. MAI 0',,,,rt4 \144120 4 0 Lc 01 cv o 8/ f Xi . r • t- ., 2a ' /3-S- ' ' o 1 o -s-1 rood 6a �o — 6071 "?D , ..,i''/ -,......., / <----..,......., LO' / GO' Sae r.2I _ 477-i4cNs D /CAT ,1 :7e0m0lo � ctu �f 0/�l:�, Fla4DoT 2 S c) y03 I I I ' 00 ? . 09J- t�, c � 12_ �>__ ✓ 11, !'Ulite -rE !�L , : — 4© T ' .3 LocK _i- /a,eiee,e as,i Mez_r.