1984, 07-18 Permit App: 00001421 Residence •
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)(mI D�rtment IJ Only
• /1?(C1i77iC/� (--b//1// J L j
F . 1// Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
/19/5' `, SUP
3 City/Community State Subdivision/Plat Name
i.'ee/-7e-zeces a-2g _ e1/ /7 _/c/GC' 12) 6ree,2r cis
4 Assessor Parcel No. Lot Block
e:,20•57532
_. ' e) / q / * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.ffC. �� 1 —8 4 Zone Project No. 1/-17
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
2 - 4 Aca 'moi
7 Set Back-Front (L)S-1 r (R)S-2 1 Rear Census Tract Module No. Initials
&,--/ Z7 ,-- , gold m
* 16 Architect Firm Name
Street Address
Zip City 'State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm NameStreet Address
s
Zip City I State Phone
( )
Contact Person 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 PlaQ Check(Y/N) Other(Y/N) I SEPA Exempt(Y/N) Date
15 Type Work XL-, Bldg ❑ MH 1) New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
ill ►17 E—
10 Applicant Name Street Address
( // /_ 0 / 3V /''�,/cKr E/ '/ ' / `—`'
)/ /e
11 Zip City State `Phone
* 99oz3� a�l'.�'u/ G�� ( ) 9;719 y,7
Lender Street Ad *
EGIV
Zip City State Ph e
JUL 18 1
Contact Person Ph f different than above
Additional Information
43
14c r F
6,- C--7_ 1(6 �c_.._i4 ff.. t o o6 4 cArl3
c
•
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 to-rvd
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition "^7~,k
Room 200 . ❑ Additional structure;
/
APPLICATION# y 7`'9 g37
Conditions/Comments: ,/ / ! 7
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone;
❑ CU,variance,zone change;shoreline; 0 fence;
❑ Other
Conditions/Comments:
Engineers: 0 Commercial; ❑ Residential;
0 Flood Plain; I�
N.811 Jefferson ❑ drainage ' new access/approach; ❑ fence;
O road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam 7 1 r
Fire Prev.
Conditions/Comments:
a
7.0
m Project Representative Telephone
a. Agencies Performing Special Inspection:
U
1.
0 —c9 �p
E 2
LL
c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
j /rec.z ( .4--/ i_.:- 1/2(/c--/
I.
_., .
' I / i
• 4 I
i1
•
--. !
• Cl- w &&ei 1., I
e 5"D'F200- 5 ree--/—k•
/
3i
i.
/ , .---. 2g.1 "---7' . .
. • i
H °'- V 5 6 I -
.7,4(041L
• 1 I 6 74
/
- ,r, ,e • ' . i
I -
3g.) 1\ 1 IT . .
,
;eT
j /
•_ 1—,‘ . ,
/
3 C)
- .
Z , +.•>.
:5-°.--i - . - - -
I
. I 1?e T-• ----r--
. CP ter ; iarl
1
' 1 LINA.) ' ' ----- aoc
i/virAtO
-......1 ,.
I
>1 _ ,..._I
.-.1
7 1
, t 1,58 •
I
. . .
.._ . . : - . .., • .. . ......„ . . _ , .
. ---k
• ' , . k-< . -
. . .
. . • .. • - - vkl - - ,T.,.-..
. .
,..
_ \4
.. /-1 61624..ev-c-89ao
• R - . t,m144,
. i
3171;:::71,,:a „,,..5.UKTY HEALTH DISTRICT
c3,1 ,
0- 0(
, Li IT.q ic 414 k , rA.A...1,14. P.4441:401..t %get rt'444141k
r F crsv-raci" c•e0044.s. 4. abisgW 1
Polobova.,:a. opisiv- Lut $efr r
iv-. pve 4s Thi D-34 5 fe 53)R. 3
g a.% 44^. . fax-.....e 4blvoot APIA
a/
-- ---.-.------- 4
.., •
-k
1 ./Ct< e)
74-e_
., ....,.
„ -
5/Ke
. r
• ;i
I
' Ga
0 !
. ' •• .4\ .
0 0
t- • .
„- • -.0 - • 5 PL1-11 VI I
a
!-
\I ,..
. / • \
.:-
I
7 , ---7 . I
----- 'd / . • I. ,
i . .
.
- i gpailit i-•--------
. I
-c 12-°----/
•
• ,
,) .,,V• .
V(
,,,„4----&-----7-----/ . ,
--------j—Tor- 4.- .
4
.- ----,"- 4) ', /
------- LIZ - ell• ‘..-%
.. —_
e-----^----------------- ..._. •
. . . -
' I
1 . !
M
7
. --- I S-s
. . , .
i . • . Q
., . .
‘3
: \
.4,.... .
VI .
. • . .'.•.... - ,
47 • -
' 13- 1 /.'