Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1984, 05-01 Permit App: 0035 Addition
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) Owner's Name (last) (first) (m) In-6r�r T -- 1 /p E-014-61-17--- {L partV�UseOnl Y %s. comm1 2 Project Address (not Mailing Address) cr Road Name Space Zip P/-/-)9?// /74' 40erx&v 3 City/Community �r,k ter State i Subdivision/Plat Name �j -�CAN`.S .414 iC•• 4 Assessor Parcel No. LC ^ t- ,j 1 _ zS OC _ t l� Lot Block / * i * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.t.# Zone Project No. 6 Dwell # No. of Buildings 1 Sq. Ft./Acre Depth [1 C ' Frontage 1-2-7I 7 Set BE -Front Xr -r ^ ,t'S�,T- 1 (L S-1 I j I (R)S-2) � R Census Tract Module No. Initials \ 11 N 16 Architect Firm Name I Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name /jet 1-€11-4/ /froris-i r- 9<„0 5,1--c;CC// rtr 4, Street Address Zip 2 U City .I n able 6tate &Cc. , 5 l-, Phone (Ci 2,0 3J_'3 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 (Y/N) Other (Y/N) SEPA Exempt (Y/N) Date 15 Type Work Cg.. Bldg ❑ Fire ❑ MH ❑ Demo ❑ New 9- Add/Alter E Replace ❑ Move ❑ Other 14 Describe Work ' I 5 ' a -z' DIi1aN TO (�fi Pr vSF 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 Application Type (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) Environmental Health W. 1101 College Room 200 ❑ Commercial; ❑ New Construction; Additional structure; APPLICATION # / y ?(22_ 14,/,-// Residential ❑ Bldg alteration/addition Release Release w/cond 1 Hold 2 // Conditions/Comments ClpytC ye-iZ Lcib ` etuctri Fre;,-,.i / �, ptoh_�©,�.� Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; E Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments• Engineers: ❑ Commercial; N. Residential; N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ road improvements Conditions/Comments• ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions/Comments• Other: Plan Exam Fire Prev. Conditions/Comments• Project Representative Telephone Agencies Performing Special Inspection: 1 3 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold 1/r