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1985, 06-21 Permit App: 00006065 Residence ,r 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'sJName . (I t) (first) (m) rpartment Use Only K�Y1 L r / 7/J € . Comm 2 Project Address(not Mailing Address)ar Road Name Space Zip . 12-O O6 54eA,i� i- 3 City/Community State Subdivision/Plat Name S�GiraYle (A-//q U/v/UF'$fTV l Gn-- - 4 Assessor Parcel No. Lot Z Block 2^ C�/c/ — /95 / Q 2O4Q' /�j . , t DEPARTMENT USE ONLY * * * I1 ,J`7`f / 7 7 ( Q (� 5 Sic Code Zone Act.# Zone ���� � Project No. C/°6' 6 Dwell# No.of Buildings Sq.Ft./Acre Depth f Frontage 1 (� .75 7 Set Back-Front t I(L)S-1 � (R)S-2I Rear�I Census Tract I Module No. Initials �/�� 30glaZ h' 8 „-.I (I(Q V ► 1 * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contr Firm Street Add rLIAKQo ^s� • o. �� �O Zi Ciry, State Phone 92a?7 ods Ordgrc5 wfr? ( ) Ia2o2 -31o`/ Contact Person License No. Phone if different than above Yil c 1eLk K-Wit!-x -as 6 `D---(0 ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date 15 Type Work Bldg ❑ MH 3K New ❑ Replace ❑ Other ❑ Fire 0 Demo 0 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 Yh F = ( f U _ 0 64 2; DEPARTMENT APPROVALS 4. 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 fl Early Start Release Release w/cond 1 Hold 2 "" Environmental Health E. Commercial; El Residential W.1101 College `X New Construction; ❑ Bldg alteration/addition Room 200 El Additional structure; APPLICATION# ‘ , `� 72 7 Conditions/Comments: �.--c� b C� L77 0 Planning/Zoning: El Commercial; El Cert.of Exemption; ❑ Frontage; _J J N.721 Jefferson El Setbacks; ❑ lot w/d; El lot size; ❑ use/zone; El CU,variance,zone change;shoreline; El fence; El Other Conditions/Comments: i V't-1 Ri Engineers: 111Commercial; ElResidential; 111Flood Plain; N.811 Jefferson El drainage new access/approach; 0 fence; ❑ road improvements Conditions/Comments: �/,�4- 7fc , El Utilities: N.811 Jefferson Conditions/Comments: O Other: T--- if j E Plan Exam / ' Fire Prey. Conditions/Comments: c co c ❑ Project Representative Telephone a Agencies Performing Special Inspection: co Y c 1. - U '- cp N F` E 2 ho f0c 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold s. a . l�h Eb • a ars'IM'SONVHOSO SILO • ,en xos'0 Ab Mfg I AMM-tiara°d I` Nouanuisd . •' 1,01AE-Vt � osi - - - • \ . t . • • � 1 � I Q • p 1 \ ;1 I • I Lr. , Wm • z o • e XI °lib C.. • }ua�, 0� 7w►oH '5a5 lm I1 • •. • ,5 e►ad u , 1 ,u ._ p9 ,wQ ,F1/0 T.. .__. : :_ ________H .._ __ :. ,.. „,, N iT I". I ‘ •