1984, 10-15 Permit App: 00002835 Addition •
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAr.millii."ND
(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
61
Q. 1 )�{ Fes. / Comm
2 Project Address(not Mailing Address)or Road Name /� Space Zip
1111 . H H o o s-- dc-q 5, l Q o 42
3 City/Community State Subdivision/Plat Name
_S-'7)ct .4"t .-, 0. (4/41s4 C)f ZLl.( i tTT ' C-(`--c :
4 Assessor Parcel No. Lot Block
lj,(j-,.%/ `'�� ' 6
�� era 1 r Si * * * DEPARTMENT USE ONLY * * *
5 Sic Code —T Zone Act.# 7_one Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth 1 Frontage
k ( f� tie`
7 Set Back-Front I(L)S-1 (R)S-2 l Rear Census Tract 1 Module No. as,,,..._
* 16 Architect Firm Name Street Address
Zip city State Phone
Contact Person Phoneif different than above
G9 ;t-e• .4) €.4 '< `l ( )
AV le el JC'
Contractor Firm Name Street Address
Zip city 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 Ch k(YI N Other(Y/N) SEPA Exempt(Y/N) Date
• /6-_-_S
15 Type Work /Bldg E MH ❑ New ❑ Replace ❑ Other
❑ Fire E Demo gr Add/Alter ❑ Move
14 Describe Work *
A/42_
/ / //-0 `, h ,,(��/,/r7y25,-) 6
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
kilt0 tra6 IQ 01 14AFAJ trPP Ill0 7000
I 1%1-IN f&o pii wJ
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; sidential nf� �
W.1101 College 9 ❑ New Construction; Bldg alteration/addition , l
Room 200 ❑ Additional structure;
APPLICATION# 9'--/e,2/Cf
Conditions/Comments:
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:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey.
Conditions/Comments:
a.
c�
co' Project Representative Telephone
Agencies Performing Special Inspection:
co
O c 1.
U
IQ c9
E 2.
m
LL
c
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
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