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1984, 05-04 Permit App: 00001145 Addition 4. 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) I Department Use Only /iilV\ttr\0.v17\ lie V\ht S Res. Comm 2 Project Address(not Mailing Address)or Road NameSpace Zip s� 2_01 Z i 2._::2.F__-, jee itom e ' -7/ `1% Q 3 City/Community / State Subdivision/Plat Name p Ki1NCI , r1 4 Assessorl/ P/ar�cel No. �J��—0) 0 6 0 Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone A6 ail c Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Depth 1 Frontage I I 3oz I 6 0 7 Set Ba©Olt fi 1(L)S-1 I (R)S-2 1.t Rear Census Tract 1 Module No. r Initials Al1 t 1 - J c tJ Ar * 16 Architect Firm Name I Street Address Zip City State fl Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address i`StAi TL -77 C_o^i ? k.0a4t=;rN. 370'{ i\\ 7/-/oz,-7E-- Zip /-/oL7`Zip City State Phone ( 7c7 7 �'` s D���a -ds UV (f07) _22 (_ —/ C)7 Contact Person License No. Phone if different than above �c LA / 64.,,--:/--/r2, / ( ) = .....b4'� 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date 15 Type Work 7` Bldg ❑ MH ❑ New ❑ Replace ❑ Other ❑ Fire ❑ Demo iX Add/Alter ❑ Move 14 Describe Work � C AP� 1511 N6 6,p6Ery\ T 10 Applicant Name Street Address PCti(...4_ I N , i',-r- Ie- .6 e-ve. 11 Zip City State Phone ( ) * * Lender Street Address Zip City State Phone ( ) Contact Person _., -1 Phone if different than above ,.-t_1,. i ov ("rr / /� Q_{ ' 1p,/' ._. ( ) Additional Information c ').FF-C'tP41INSPSCita1•1 fOni (,T)N 6 O 1 VVI A I((., k.c. ry- UC( ' C�14.‘tz--f t✓ 440 1' a r r 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 Environmental Health ❑ Commercial; ❑ Residential .I W.1101 College ❑ New Construction; % Bldg alteration/addition �/04 Room 200 ❑ Additional structure; APPLICATION# 1 4 f 41447 Coni itions/Comment • /I i . srrr I.,.'�.+ iy4 f-- - hot _ 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: E Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; ck N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ oad improveme is / -� . Conditions/Co men dif OIL Utilities: N.811 Jefferson Conditions/Comments: Other: Plan Exam I?:k 41 Fire Prey. Conditions/Comments: d c❑ Project Representative Telephone Agencies Performing Special Inspection: O c 1. Li co 2. N OE LL 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold 1111, ( { Eyt4Itt.16, c 'i +I 0 o i \N L 1. E �" L e