1985, 06-28 Permit App: 00006165 Duplex 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)
I Owner's Name (last)L (first) (m) Department Use Only
r i
1 'il—3 J t( 6 s. Comm
2 Project Address(not Mailing Address)cr Road Name �� 11�`l� Space Zip
3 City/Communit Staite,� r SubdivlsiontPlat Name p t t
X t2',f—� c t/lf $`f- ` O Z �t�� G
4 Assessor Parcel No. Lot Block
2�S/( - - 9013 Crogeob) �r ,t * DEPARTMENT USE ONLY �r �r Ir5 Sic Code Zone Act.ff Zone k9 Project No. /' 1
Cei
6 Dwell# No.of Buildings -Sq.Ft./Acre Depth Frontage
Ifl ' 95 )
7 Set Back-Front I(L.5-1 t (R)S-2 Rear Census Tract Module No. Initials
2S ` 13 .S 13.xI — ,.IUL\ rn .
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm Name Street Address
114;
Lies
Zip City State Phone
,,,,,n,,,i,'03
Contact Person License No. Phone ifdifferentthan above /
!--)01-1A!--)01-1A1A (ufdver1 ) 4 haZ 4 , )5e
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) I SEPA Exempt(Y/N) Date
15 Type Work Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter 0 Move
14 Describe Work
10 Applicant Name Street Address
11 Zip City State Phone
( )
* Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
rn F -=844 x 2 = 1766,5
U13-544x2 = 175
fil
PcL .--- (an X 2- )r'o
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.) r
❑ Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
,
(V KEnvironmental Health s Commercial; ❑ Residential
W.1101 College AN New Construction; ❑ Bldg alteration/addition `�,-1 -O
Room 200 ❑ Additional structure;
' y9 ,(,)0,-D7.
APPLICATIIIOON# a 5--.6'7 3 - _
l'a
Conditions/Comm � / �S /
��� > /�� ' _% 0
./
4..--",he, ir�eti
, / f/
0 7t Planning/Zoning: ❑ Commercial; 541 Cert.of Exemption; ❑ Frontage;
11)6d/919N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; a
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments: C ft f /'LC C 550-z,-i 0 ,t1,,__„, c,,i) t)(7 .5p e'/- -z.....
�l it i
Engineers: 17] Commercial; ❑ Residential; ❑ Flood Plai ,; I
. N.811 Jefferson ❑ drainage new access/approach; 0 fence; ,.��lj
❑ road improvements !„��
Conditions/Comments: lY
CI Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam * 'Y
Fire Prey. '
Conditions/Comments:
a.
as
c
•°❑ Project Representative Telephone
ca Agencies Performing Special Inspection:
. 0
c 1.
as 173
i-- E 2.
y o
as c
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
1
To7-4L of e-06 , 7, y' 1'c,/Cl/
/414 .54/7 t
^ 4' A
/ \I
PeasE RIAm r,�, "Pre 72/1
Asrm 'D-30j� SDRAm-.3f ® Zx m-• `44 --
atu.t i..10 gx.ve 44,...,it,. T rk......
t ,
- i i ----- '7 .
- — -- -- 71-)- - - -
III l . 1A-Ic i Li; b , i
: iiv >
• 1
A
' • C. ,46 ,, 0 .
N) i Jul(
i ;-/ \
I, viilAtti;),, • L _
in
1%\► ' SFE �--,19 �� � . \„„,.._\,),.,i1„_
\:\
.:/\131, 1 N
)„.,e .
. ys/4; ee-
,...„..
,,,,,,
_Li, (
„ca. ..,),,, v..,, r.,
.15
_ ec'rPS ,90, Pt(1_
W Y