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1985, 05-30 Permit App: 00005657 MH 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 f (last) (first) (m) Department L e Only £l f ;o-it 1 17 Q Rse. Comm 2 Project Address(not Mailing Address)a Road Name / Space Zip ,ri010 7 E 7'9,2(2 3 City/Community State Subdivision/Plat Name aSS?20;(4-uE SIfzES-Z +4r�0 4 Assessor Parcel No. , Lot Block -Z.55 -2'' , ` - Jt4 .._ -- •. * * * DEPARTMENT USE ONLY * * * / 5 Sic Code Zone Act.8 Zone 'Project No. , 6 Dwell 9 No.of Buildings Sq.Ft./Acre Depth i Frontage 1. • l . 135 —75 • 7 Set Bads-Front 2 s I l(L)S-1 • _ . I I Rear- -...A . aus Tract I Module No. In'' s 2?,---- * 16 Architect Firm Name Street Address * it R. I . Zip City - State Phone ( ) Contact Person Phone if different than above Contractor Firm Name • S_.- V I Street Address Zip City 1 State - " Phone ( ) Contact Person . • License No. Phone If different than above ( ) 8 Owner/Agent(if differerft than 81 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(YLN),�- i SEPA Exempt(Y/N) Date ' 15 Type Work ❑ Bldg 0 MH 0 New 0 Replace.-, at.n9 qer ❑ Fire ❑ Demo ❑ Add/Alter MoveNrr- _ •. 14ibe Work / j� 7n°/7Dve %&b,./ /7/0Jve orlf© 1x7- 10 Applicant Name zfilly p, E11,07 �O r� Street Address ` .4 11 Zip! 9,2 /. /City' olrak e - ''i` •" a 1 Phone ) J J / !O F-2, ,- Or::.. * Lender Street Address • Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 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.) 0 Fast Track ❑ Early Start Release Release w/cond 1 Hold 2 if. Environmental Health 0 Commercial; Residential W.1101 College 0 New Construction; 0 Bldg alteration/addition Room 200 0 Additional structure; APPLICATION# A /so g7 Conditions/Comments: knoteA4 Haan. p )(70 JlJ' _`Q tyieul 5,j} 644 0 Planning/Zoning: 0 Commercial; 0 Cert.of Exemption; 0 Frontage; N.721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU,variance,zone change;shoreline; 0 fence; ❑ Other Conditions/Comments: lir 2/ Engineers: 0 Commercial; 0 ;Residential; 0 Flood Plain . N.811 Jefferson 0 drainage 13 new access/approach; 0 fence; IV rir\road improve ent ,_ T�k 3 E Conditions/Comments: _VIP �h, ' n(,) Cs, VcCOLO )(•. - O Utilities: N.811 Jefferson Conditions/Comments: O Other: O Plan Exam Fire Prey. Conditions/Comments: O. cn li Project Representative Telephone «a Agencies Performing Special Inspection: x o 1' Uco 76— ►- E 2 C LL. c 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold . 7 : . ' . • . . • t - • 9 . ,. r . . I I . I 4 54:*4yr) a •0 1 1 1 1 i. -7.•AI - 4,fti 1 r)! , \\1, ...10.1 "411' • J„.. I - t'' ..,, •. • 4 1 ! 1 ----\-- ' _ c ' • r 1 '0' t y1) 6 \-) . '1 k•1°-) I _ . Q , ;41 • '. ' • zi;"e p,/,.,,t 7.'::"; , • 14 a A i Vt,. I11‘t (/ 10A t 1- 1• _ . . . • .of . -17- z tJo , . it't. .? _.0_44- 4-$40-4-A±14A1 6 --te alia.$1,6,J. ..11.tets:7 e4o.ileto . , -(21-4: 1 1 ; II I • • ad, i 4 Val '12 .01/9r. • 111......".".71 • ..,_ .. . . . . ._ .. . .. _ . _...._ . . _ . .