1985, 05-10 Permit App: 00005234 Residence BUILDING PERMIT APPLICATION WORKSHEET l\l
PLEASE PRINT AND COMPLETE'ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Z
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name / �((llastt)) r / (first)pst (m) DepartmentUse Only
40/1 L-0/2, /1141/i/1y /., s. Comm
2 Project Address(not Mailing Address)Cr Road Name Space Zip
- 19310 1T kuc -
3 City/Community State Subdivision/Plat Name
!r1,'S .5l S So 40iv1s/Ae_2 •Z61-- / ,84ek 5/
4 Assessor Parcel No. Lot Block
L 4.1 . 3,r0 I r 4 * , * DEPARTMENT USE ONLY * * *
/A 5 Sic Code Zone Act.# Zone I R_i
E Project No. J 2 4
‹,././1
/ l
6 Dwell# 1 No.of Buildings Sq.Ft./Acre Depth
/n i Frontage
- 34
7 Set Back-Front I(L)S-1 1 (R)S-2 i Rear Census Tract I Module No. Initi Is
'.-) ' - t o I f Jif N m ,
16 Architect Firm Name (Street Address
7`y,v.,,Y to-si .-e- /Svc 1 &x /S'
Zip City State Phone
? e-o'? K r ,03446- lv/rsj.L-- ( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH X New ❑ Replace ❑ Other
❑ Fire ❑ Demo ' ❑ Add/Alter ❑ Move
14 Describe Work
Q ))(g— w/ 6AnAGL-
10 App
licant Name p Street Address /
A - City State
�5�1 - State ,..5r� V�//1 C7'�S /
11 Zip
99a/- S /SSP .vXT-- GiA 6/Y ( ) 9,?,6 7?,3 C
* Lender
Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
pF V 127-4
OS 512
Z = 52,00
( .- 577
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.)
O Fast Track
O Early Start I Release
Releasele)lifill,/85 w/cond 1 Hold 2
NEnvironmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 El Additional structure;�st
APPLICATION# . 0 5- 1'2 7
Conditions/Comments: 1714-711/7741-14,
❑ 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:
Nr Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; 1,4
. N.811 Jefferson ❑ drainage ,'! J new access/approach; / I/
g ❑ fence;
CI road improvements ` /
Conditions/Com encs: ...‘4, ... _`�� ��_ •r_ > ,. ,�,1
-/YL/ r-'0-G�Ge) • 4Ll,vr 7:2zz,�,.2r.ez-:-` i
El Utilities:
N.811 Jeffersonjp7)'-' i
Conditions/Comments , , • , d 1
/? &402 5A7 /frmef!' "7:-)rwi,P 1
El
Other:
—
,.k)
,-
Plan Exam
0#41---
Fire Prey.
Conditions/Comments:
a
Co
c❑
— Project Representative
Telephone
ca Agencies Performing Special Inspection:
. O 1.
U '-
i` E 2.
m0
V_ c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
` �'��P' � /S3/0 /3 A v
j _
4
7_
. \ 1A
\ 1 I i
�} rl A
_;--- I/ /VC 4,4,,,r sew(*.t . I� 1TA7 I ! I
\ I \� J i
q
iQ ,
* \
_ I .
} r / err
1
M c
! zs