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1986, 08-14 Permit App: 00012655 Addition (THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) SHADED AREAS ARE FOR DEPARTMENTAL USE Protect Number /r4 51. �J Owner's Name ii_y_ii, �_ FIRS 7 MI ` /7, Project Ad s(Street Name&Num r) 71 Zip Applicante Address ri ' ._707t-7 --5 :2---- - /' ''' -.6 ----", ‘ C ��gzioj State � P�P. Q6Phone ?C-7 Business Phone ( ) Contractor/Agent ,r Address City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer �� Address City State Zip Phone - ( ) Contact Business Phone Lender Address City State Zip I Phone ( ) Describe Work [Res. Comm. t3ein 1200 k Cleo Subdivision/Plat Name/ShPlat Number U Ko/4-/C• fvw�vs LI)'k- L S A-L.L Lor-(, / X3-7 Assessor Parcel Number Lot Block Plat Number 285V2— 23c iti Pertinent File Numbers Zon� _ Comp.Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage / , a•-ii ( if 3© ,- Front Setback I Left Setback l / Right Setback Rear Setback R/W Width Additional Information Square Footage Z 0 1- Q 2 iz O u. z O Z a J 5 m Number of Bedrooms Building Technician 0114WDateGroup Type 8-/V-)86, 3 V T DEPARTMENTAL REVIEW Cond. Approved/ Approval Hold / Environmental Health Application# ` V6 ..g7 84 w. 1101 College / i / ` /A� Room 200 _i1nt1�c/d . V Planning/Zoning 0 N. 721 Jefferson , I7 A. e • G4 1' 1/ a2� - r., f • ii .ts L'✓f F . ,_111_:a�_. i 1,1•4./ l .7 1., ,.r /CJ f, -r / ' SLI_y/ �/o ;',/4 /�/i[!y a '� re," fit. 74 p •:0-011$4.N // ,-1 47C' , /49.../49..../4 fl-v Engineers ❑ N.811 Jefferson Utilities I ❑ N.811 Jefferson Plan Review/Fire Prevention %�-- al N.811 Jefferson 4� Other(SEPA/Critical Material/etc.) ❑ Fast Track/Special inspection Information Project Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to compile sai a(iplication is true and correct. /�f 7:- o/- - Signature � Date__ `- . ~ ^ ' Show on Site Plan: Additional Information: ' 1 ' I , . a , 1 ailimmi . , : 1 I ! i 1 , _ _. _ i _j__ 1 __I __,______,______4____ Existing Structures Drainage Plan [—. I —/,----1 Proposed Improvements Hydrants ---i- i ' - i „...., Structure Setbacks Topography Easements Lighting �-�- Septic System(s) SignageI i — -If_ r 11______ ___' _4 Water Lines Shorelines 0- Sewer Lines ` Highwater Mark Fences,Wells | Driveway(s) i ; I Righ1ofVVeyV0cbh�) | Names of • Fronting Street ' • / Ro��Q�mn ' � / Legal W 11/Z- S_ A kJ-, t.--e„, g_ . �° �� ~�' W41,d �[��/ /, — , , - ell .2_,, , , _____ " , rte ' � ~�� - -- - / • - - c | ' �� ( | | ^ . | l ` U | / - 8 ' ._ li � | / ' ` | ' �� ' | � | � | / | � | | i | / � � ! � • | ' |� | _| | | � ^ - ` ' ' - � , - | �_ . � | / | | ' | � | | { � ' | | / �- - --�--�- | i --�- | � - | --+ i - _�-_- | | | | | ! / | | � | ! | / / ' | | � | | � | / | I ( } | T ' | - | I.~ / ' | � I / 1 / - - / - - ' / | -+ | T1 |- - I1 - { / | }! - | / • m --- | | i , _ -f- � Ht - -- -' '/ | �-- | ! - - !D:u�' Date: _ / Rnv�imm: Attachments: 4 - / __� | | i 1 | � H � / .- f | . . ` ` � ^ . tt