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1985, 01-14 Permit App: 00003911 Siding, Sofit, Fascia °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 p (last) (first) [(m) Department Use Only f411crr Iy\rt{) n -Ken b1(-1-1,-\ I\ , Reis. Comm 2 Project Address(not Mailing Address)or Road Name Space Zip N L 1Lf2-0 Ui(` I b(kv Roct 9 iaoC, 3 City/Community State Subdivision/Plat Name 6 poKcvnc,OA Pecs OA/ rill 4 Assessor Parcel No. Lot Block /6)5 s ,/ _ s / 2 * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zo &245ne Act.# Zone Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre ^ Depth Frontage 7 Set Back-Front (L)S-1 (R)S-2 {f r Rear Census Tract Module No. Initials 99-E-V * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address P LUGc.iq ezAizAherg ra c-b rS 1 C. _ , 3/Q rte Coccc(_. Zip CityState Phone qg�i A Sp-a>k e 1 (1,0A (59) 9a s- 6, V, Contact Person License No. Phoneif different than above 1- urrLi MciJcj Mc�!AYfG3L �)G ( ) sem- -- 8 Owner/Agent if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(YIN) Date 15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace X Other y�/ ❑ Fire ❑ Demo ElAdd/Alter ❑ Move LP ro.te- 14 Describe Work 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 5- 6U. I /i-- CC( Sas__ Vaiutc A rm `6 55a . , (Da Y ti tivu '" P.P. - 4 S f CC) DEPARTMENT APPROVALS a; • 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# Conditions/Comments: Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; D 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: ci. •°❑ Project Representative Telephone cn Agencies Performing Special Inspection: 1. Y o U c0 N E 2. o ca c u_ 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold