1985, 02-26 Permit App: 00004333 Residence i 67
r
BUILDING PERMIT APPLICATION WORKSHEET 3
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)
a 1 Owner's Name S (last) � � (first) (m) Department Use Only
�-�\c ‘ 1\7`C\e-e_ MC Comm
2 Project Address(not Mailing Address)cr Road tlame Space Zip
_ !� 3 t S, 0-)4. sem 9 o3
3 City/Community State S��urrbdivision/Plat Name `�
4 Assessor Parcel No. Lot Block
.S-- I _o 1 , 13 1 j * * * DEPARTMENT USE ONLY * * *
_5 Sl�(cc CodeZone Act.M 4 Zone Project No. 7
I 1 - 7 _
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
_ i f /tte 1,,/Or
7 Set Backyont (L)S-1 (R)S-2` Rear s Census Tract Module No. initials
(pad
16 Architect Firm Name I Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm Name�` StreetAddress
Fit-%kk2 Ntye� Xt./C._ . I 9q 94 gd U4-, u.)
Zip CityState Phone
5 3 3 SIA de ►� LA k.� 'fid , ( a > 7 9 - /,b /I
Contact Person License No. Phone if different than above
_5�i t;a k k FLN�CL III- C R ( )
8 Owner/Agent(if different than#1 above) IBusiness Address
fit /d a' Au r--.A__
�' �G —
9 Zip�� City State Phone
_ 3? ��.. A- k ( '_ •) 7 �— 0 *71b
12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(Y/N) Date
gm
15 Type Work C+3-Bldg ❑ MH (e''New ❑ Replace ❑ Other
�
//
D Fire ❑ Demo
/ ❑ Add/Alter D Move
NM14 Describe
Work SiC Co e, 0--i/G-1.1/,6C 6
MIN Ell 1
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
t7peffact(3.m vc 1 Z-2,e a
IC I2. -:- Mr iso = clack
60`f - SF
2 0 C ttC e r'/a tis Pe i rN ec/ ,*'3/4 2.-/es
.
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/addition
Room 200 ❑ Additional structure;,{
APPLICATION# -60 7y
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
E CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
2( a �y
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; _/�
N.811 Jefferson ❑ drainage ❑ new access/approach; E fence;
❑ road improvements
Conditions/Comments:
CI Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey.
Conditions/Comments:
a
C❑
Project Representative Telephone
Agencies Performing Special Inspection:
cn
c 1.
Y O
E 2.
O
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
•- P fc nc•. / --0/ 44.
i f /42,‘/2//2
/3 , 8/x / •
� �
tieafle� Ark l�Jd,llon ��
i 7!e c:F • oP Sooko le
Scale 1' ; q0
•
) 3 k s , ,..._1—) ek_ 1st,r...)
c.,--) ,ap,tie, -:„,,,fe/111'1%'
(1 Ail ,
` 1141;I ;,
70.s ' i 4 2-.
(Pilii.dpuviiiit
O,h /V 3
Ave �c A,�,�
QZH •, ti -�_poop - I Se/et
al C94 it'lc
0.1713 ii‘
,I I--1 1 , N
, A
1 1.2. p _v4-
•� , w
:o
Road. . 1 i
.
. Ease/e/17'
1
r•
— — — — — — — - -r,
'51 U-f�li/ Easemehf
I
fp�n/1 �P /dam eS /JC -
l /f /%?
//c/�� /
�//� gypq f 4
l�P cl1:y . d-P Spoka5e
Scale J
3 r� � wR/eh s c a r►
v
(
-170,83
071/
i4V e 4"%f • / b
I
Jet• -9, 85)
-E—_/0 00 C 1 Sep
- m Tan A-
1
rt---9a --
)11 /21 a
iII
I I 1
ROOd
EaSemenf
H _
�5I Ufa/1' L4semenf