1985, 08-27 Permit App: 00007100 Siding •
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 (� (first (m) I Department 1J9e9hly
ill (firs),-)
ii//1 Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
1
3 City/Community State Subdivision/Plat Name
4 Assessor Parcel No. Lot Block
v_544 /j�/,,...q * * * DEPARTMENT USE ONLY * * *
5 Sic Code ZoneAct.# L / Zone Project No.
40_, `700
6 Dwell 0 No.of Buildings Sq.Ft./Acre Depth Frontage
mac
7 Set Back-Front I(L)S-1 (R)S-2 l Rear Census Tract Module No. Initials
r
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
roc.�/�., / n . 3/ah 1 ,'
Zip City State Phone
X 12. ° ki (5-09 ) qtr 96%
Contact n License No. Phone if different than above
aiftr, e f� 147 i 1/ 3'/ /19 ( ) S0tc1,n
8 Owner/Agent(if different than#1 abo ) 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
El Fire Fire ❑ Demo ❑ Add/Alter ❑ Move r
14 Describe Work �,j�,. i �� /'
5[I/g / .(/1,c�1 � i6 Qd---`�Q.d/r��/�`�
10 Applicant Name O (/ Street Address
11 Zip City State ' Phone
( )
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
0 116/4 = it/. 5-57.5T- °6
PeA . -ee : 166. 0 6 f / . 50 _ 6q. 5;,-)
•
•
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.)
El Fast Track
Early Start Release
Release w/cond 1 Hold 2
El Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION#
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage;
N.721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone;
O CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
E Engineers: 0 Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson 0 drainage ❑ new access/approach; ❑ fence;
O road improvements
Conditions/Comments:
El Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
111 Plan Exam
Fire Prey.
Conditions/Comments:
a
c
c
° Project Representative Telephone
�nAgencies Performing Special Inspection:
1._
0 O
U —RI
E 2.
o
c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold