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1984, 09-13 Permit App: 00002263 Garage 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'syName /i(last) (first Z)////Q/7/7 / (m) Department Department Use Only 7/ 6 A /.rf i ePC LL/////Q R3s. Comm 2 Project Address(not Mailing Addr )cr Road N e Space Zip .E /,l9/5 —'7&cS77 9 9o/( 3 Cit mmunity Stat Su Ision/Plat Name /flai eile� 2/2 ovb,r, 4 c%l Otee/76(1e...5 4 Assessor Parcel No. Lot Block ( * * * DEPARTMENT USE ONLY * * 2_0 c-J 2 0156 / ._5 Sic Code Zone Act.# Zone A Project No. r 7 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage 2-- t0e)0 /lob 7 Set Back-Front I(L)S-1 (R)S-2 Rear Census Tract Module No. Initials 155 't0 , , 9-, * Street Address * 16 Archil �^mg Name / 9/2 6 ._---- Zip City State Phone ( ) Contact Person Phone if different than above ( ) - Contr or Firm Name Street Address // ,��� S / £ / ps /7/ rJ ���ei<T 57` Zip City I State Phone Contact Person / Lice se No. , L'7 Phone if different than above /,),// f-t s // � 7`/,4 '''s /9,7 & ( ) 8 Owner/Agent(if different than#1 ve) Business Address .----- 9 s9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(YIN) Date 15 Type Work Bldg ❑ MH X New E Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Desie Work/ 10 Alicannt/Name r g4,44 / Stree ddress /yJy //' 11 Zip/47-5 ip City State Phone 91 * / ✓� Street Address * Lender 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.) ❑ Fast Track ❑ Early Start Release Releas w/cond 1 Hgld 2 ❑ Environmental Health ❑ Commercial; ❑ Residential W.1101 College ❑ New Construction; ❑ Bldg alteration/addition t1' gf Room 200 ❑ Additional structure; 'f �'�/� APPLICATION# Conditions/Comments: ❑ 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: ❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: Utilities: N.811 Jefferson Conditions/Comments: ❑ Other: I I ❑ Plan Exam Fire Prey. Conditions/Comments: ci co ❑ Project Representative Telephone a Agencies Performing Special Inspection: cn 1. 0 O U l4 �p 2. N O LL C 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold J / G0 j '4/;16.1 /i< (0>wIc k Gye e 7 d.-rrS 14' 4' 9947,14 g,rc�./ 2o 575 2 0/ 3 0 New I IJP r" to 4_ ho /.Z o 5Acpz 8/o A Lit C s 6f i �4 IcI /v Geer n d t Y r--" _ S '< o ?© LO ' I qi