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1984, 08-30 Permit App: 00002062 Residence c c cl Z70 A BUILDING PERMIT APPLICATION WORKSHEET • . PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UN ERSTAND (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name (last) (first) (m) I Department Use Only /17(/.06j-- et.- ie 0.1-,i de/S/ ? /-s' F . Comm 2 Project Address(not Mailing Address)�or Road Name Space Zip r G y// / i /1U� 3 City/Community State Subdivision/Plat Name 5.-P e•1 o n -"- // wet. IP/5�/eAS' ,b.Ohv 4 Assessor Parcel No. V Lot Block 2-4 . ' 0,4- * * * DEPARTMENT USE ONLY 5 Sic Code Zone Art.# Zone Project No. n OG 70, 6 Dwell# No.of Buildings Sq.Ft./Acre Depth 1 Frontage I I117 8cli 7 Set Back-Front 1(L)S-1 I (R)S-2 1 I Rear 1 Census Tract ( Module No. 1 Initials w i KY) • v11��t S S J 'v * * 16 Architect Firm Name I Street Address . .PRl,, -/n,e 174-3"f6IV /V S6 '/ O,'J/f/"A/ Zip City State Phone '11,C l-'' �,af� .V� /g ( s'r) 9J /6 e r Contact Person Phone If different than above _J /C/% �f,/N6 ( ) Cipa rector Firm Name Street Address ,+' / e'L'it •)eVN1/Ati f:' c ne'4i /V 66rJ" D/e L-'. /1e,/, fi' Zip City / State Phone yf .zDt-- 529/164--/ le I LUa. ( j mag) 7,7_G Y-Z✓ C ContactC✓ Person / License No. Phone if different than above /J,, /44.17 G /1/v,044-,C - 25 ij/ ' ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(Y/N) t SEPA Exempt(Y/N) Date 15 Type Work C( Bldg ❑ MH X New Ci Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work /V,eu> -/9,./g 10 A ant Name !� Street Address X08r,rt `J • /1111)5F /)/• G6c1` P/EG•"//,/,L<L'-/(( 11 Zip City State Phone 9177, ---- 1,'‘"°/, .e C I - (j e9`) 1x-G' Vz 0 * Lender Street Address iFilei '0-*HP ES U.,, Ai /1vp .f. e/-e_ Zip City ,.., State Phone _ 9/941,2r^/ pali dela LZ-1'1' ( S ®7') //.J'-- G 7 9/ j�Contact Person Phone if different than above ///4..'/ 1/1c/Y ( ) Additional Information 6/3,i C' r 2 Yl— Ai -: 2i Xz - 501 f2z _ 61(0tc ' DEPARTMENT APPROVALS K 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 Trackr ❑ Early Start Release Release w/cond 1 Hold 2 ❑ Environmental Health ❑ Commercial; ❑ Residential W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; , ,/ APPLICATION# I e- 1:1( c( (- //30 pyCY' ''' Conditions/Comments: iJ ❑ Planning/Zoning: ❑ Commercial; 0 Cert.of Exemption; ❑ Frontage; I I N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; I ❑ CU,variance,zone change;shoreline; 0 fence; ❑ Other Conditions/Comments: Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I I I N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements „/ Conditions/Comments: —s© ❑ Utilities: I I N.811 Jefferson I I Conditions/Comments: j Other: 0 Plan Exam Fire Prey. _ Conditions/Comments: C W c� — Project Representative Telephone a Agencies Performing Special Inspection: c C 1. a O U '- l0 ai i—` E 2. Z' O C 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold • '), ..,, Y . -s.„ •V ///3Y-70 VI1 4adli., '':74/60--e‘"a-^e 1 E_At..-E.-r-1E14T > d i' a4.0' o N .1j 1=.0' I-2_ 01 1-2-.01 11.01 12- 01 1 _ 1 i i 1 I t ,, NI\ -2 1 \ 3 ( ( --- Zoo/ ,) 1.-F f F-E g---v----t I \i • 1 ii' -6 __I 113 It 1 -0 TT L ,.-IE-... - - - , loo cIAL 4:_e.Pric, TA.1-iv) D..3D54 -0 S"rt:ptic p457/44 ---", i-L- 044... r r 4,4*. --43 . 1 , 0 1--:- -e,17_ c.„_?.F-T- (-_,vt.. ii E.4-.1-n, spla 35 19 ° 6 1 -o I Await. — .;.-set ago•-•-*.sy icD 0, -z01 -1 of•.._,, „ I i I _of -0 1 1,.1 Ji , 0 w lIl ; -0 r. -7.-----------;\--------J / . -