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1985, 07-02 Permit App: 00006188 Carport 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's Name c-+,r,�(last)/� (first) ,/ (m) I Department Use Only S'+'4/�/� .Sf./5/`9/1` Fbs. Comm 2 Project Address(not Mailing Address)or Road Name Space Zip 3 City/Community State Subdivision I Plat Name 4J,4 01\1101 ( eoke 4 Assessor Parcel No. Lot I Block 2 -0 944 ✓ 3(1 1 - c * * * DEPARTMENT USE ONLY * * * 5 Sic Code I Zone Act.# Zone ^� Project No.A (7 i a ` No.of Buildings l/� Sq.Ft./Acre Depth ? Frontage ) 6 Dwell# i 1 / © ' 7 Set Back-Front I(L)S-1 (R)S-2 RearCensus Tract Module No. Initials e)(I f )6 1 S t - Al'• M . * * 16 Architect Firm Name Street Address Zip City State Phone ( ) Phone If different than above Contact Person ( ) Contractor Firm Name Street Address P-1- f/$1./°4•4J)f ")N5.r,04/r7;:4 / w 332'/ ecv I Stat Phone r Zip City� �'A jos ) 3;2 -1702 Contact Person, License No. Phone If different than above /W/4 / /Zvurl/ '.,%4"O CX.z/p 7'.1 ( ) 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date 15 Type Work Bldg ❑ MH ❑ New ❑ Replace ❑ Other ❑ Fire ❑ Demo ' Add/Alter ❑ Move 14 DescribeCO Work„ y 10 /AAppp�licant Name/5/.0/44(.."),;t(0- 11 5,L/ Street Address v A04 `" .0/ State Phone 11 Zip City I * * Lender Street Address Zip I City I State Phone ( ) Phone if different than above Contact Person ( ) Additional Information 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.) ❑ Fast Track ❑ Early Start Release Release w/cond 1 Hold 2 Environmental Health ❑ Commercial; CI Residential 1 � W.1101 College CI New Construction; ❑ Bldg alteration/ dition `O Room 200 '' Additional structure; (V::� i APPLICATION# .n—) ) Conditions/Comments: ❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson CISetbacks; CIlot w/d; CIlot size; CI use/zone; 1 J ---i ❑ CU,variance,zone change;shoreline; ❑ fence; ❑ Other Conditions/Comments: ❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N.811 Jefferson CI drainage CI new access/approach; ❑ fence; I I I ❑ road improvements Conditions/Comments: Li Utilities: N.811 Jefferson I I I I Conditions/Comments: [ I 1 I Other: ❑ Plan Exam Fire Prey. Conditions/Comments: O. m c -°❑ Project Representative (a Agencies Performing Special Inspection: Telephone - O 1. U -N a it E 2 LL 3. 1 indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold \ j• 11 1 \ \ ; I l I 1 ( / . \ 6/D -72- r -- f 0 t ii: I . ( E1 / ° ; t /1 56, G ';= , /.� , lir is \ ,. 1 4/eicig . ._....L., '; .: ..,• . .41. r----------)t\ e. t 60 .k • . ,. : ) __ . . , ,.___, ,Z - ... . s7-",r.sz _ _... . , .. , , . (.__. ....__---- . _ _ 1 ,