1984, 06-22 Permit App: 00000810 Garage, PatioBUILDING 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)Department
Use ly
LSO �/ / 2 f 4-' �L�� T �_.
Ras. 1 Comm
2 Project Address (not Mail Ing Address) or Road Name Space Zip
/ 3 7/-) 5-- Tii /7 11�
3 City/Community
512cDX-09.4.../.
State
!NXL .
Subdivision/Plat Name
GTS ' / .52'i9.27 ,
4 Assessor Parcel No.
-2 2- I —o5C(
#
Lot
Block
/
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.
Zone '�FN
1z-
Project No. g 1 b
6 Dwell #
1
No. of Buildings
(i`
Sq. Ft./Acre
Depth t q Frontage
14-Z C:
7 Set Back -Front
(L)S-1
(R)S-2
Rear
Census Tract
Initlats
Module No. ag---›,--
* 16 Architect Firm Name
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone if different than above
( )
Contractor Firm Name %
/�/ /1-% ] (/Lp/�S T /rt.,'
G
Street Address
/i'c'"-' r 4t453c-1-.,1( S c}
/
Zip
?2e, /
City
��e���1i4«
State
z„..,,,_,_4
Phone
-) e,,c,_ 5 8
Contact Person
Lam/ rN /2-7 /C' /9- //l2A/ljl2.2-/NE
License No.
r1
Phone if different than above
( )
8 Owner/Agent (if different than 81 above)
Business
Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (YIN)
SEPA Exempt (YIN)
Date
1rJS
ALV/�
15 Type Work VP Bldg
0 Fire
❑ MH
0 Demo
fid' New
0 Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
MT4Ct-€O a►i,rL4C\(
4�fkT(b
10 Applicant Name
54M/- A--,-�oy 7-7-,.;)
c?---..-
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Addressil
Zip
City
State
Phone
( 1
Contact Person
Phone if different than above
( )
Additional Information
0
Application Type
(Standard unless
otherwise indicated)
Fast Track
ly Start
- DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required In either "release' or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial; 1'SResidentiai
2,.w Construction; 0 Bldg alteration/addition
Additional structure;
APPLICATION #
(95-3-
Conditions/Comments.
s
•
Release
Release
ww/cond 1
Hold 2
2
Conditions/Comments.
❑.
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.
Engineers: 0 Commercial;
N. 811 Jefferson 0 drainage
O road improvements
Conditions/ Com merits.
❑ Residential; 0 Flood Plain;
❑ new access/approach; 0 fence;
0
Utilities:
N. 811 Jefferson
Conditions/Comments.
0
Other:
0
Plan Exam
Fire Prev.
Conditions/Comments.
Project Representative Telephone
Agencies Performing Special Inspection:
1.
2
3
1 Indicate above or attach condltlons relative to final as built approval
2 Indicate above or attach reasons for hold
in THUS JOIST CORPORATION
MARTY CROUCH
° 7834 S.E. 32ND • P.O. BOX 580
MERCER ISLAND, WASHINGTON 98040
A/C 206/232-8815
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SALESMAN: BY DATE In • ZZ -sit
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