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1984, 07-31 Permit App: 00001482 Residence
1 e BUILDING PERMIT APPLICATION WORKSHEET gti'a 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) • Department Use Only Fes. Comm 2 Project Address (not Mailing Address) or Road Name Space Zip u-- t 3807 s. waopa rci --- — ��,s 3 City/Community 5 "k- Statq`1 C "-) Subdivision/Plat Name' �d` �/� �G` 4 Assessor Parcel No. i -32 Lot 4( Block * * * DEPARTMENT USE ONLY * * * q / -1 5 Sic Code Zone Act. # Z ; oit Zone F n Project No. 4E52.. 6 Dwell# 1 No. of Buildings 1 Sq. Ft./Acre Depth -73i4 Frontage 6z10 7 Set Back -Front (L)S-1 3z %' (R)S 2 ' Rear i vs Census Tract I Module No. Initials jOri rr 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name 1 3� - r ` �, In1 tt✓' p; : e 7 Street Address \ La 3') 0 J "A (..)C 4L— Zip ?b ec, City `�Wc, State bie ' Z Phone ( ) ` 2— -) 2 ? Contact Person' IM �T rson . C License No. Phone If different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (YIN) Other (YIN) 1 SEPA Exempt (Y/N) Date 15 Type Work iiBldg C: Fire - MH - Demo = ' New Add/Alter ' 1 Replace • Move Other 14 Describe Work NEINAA!! ,\\ \-,ov6 10 Applicant Name Cr U-1-4De Street Address K23^) a..-4,,,6 a A 11 Zip ��'2©4 City_State p 4— N 3L Phone 1 1 6'2Y22 5 Lender ////// ` ( Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional dInformation �J i1► = 120- ,� _ V r/ r T V - Application Type . (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is nota Permit (Indicated approvalb required In either "release" or "release with conditions" space prior to permit Issuance.) Environmental Health 0 Commercial; 0 Residential W. 1101 College 0 New Construction; 0 Bldg alteration/addition Room 200 0 Additional structtuure; APPLICATION # trV-1 (b 7 Conditions/Comments. 4re, f;i �e-e , Release Release w/coed 1 ' Hold 2 Ft Po se illtz p Planning/zoning: s 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone; 0 CU, variance, zone change; shoreline; 0 fence; - 0 Other Conditions/Comments. Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; I, N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence; 0 road Improvements Conditions/Comments. 7 J 0 -0 Utilities: N.811 Jefferson Conditions/Comments Other: Plan Exam Fire Prev. Conditions/Comments. Project Representative Telephone Agencies Performing Special Inspection: 1 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold