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1985, 04-15 Permit App: 00004940 Pool 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 Ow._ (last) first) /� (m) Department Use Only v I ( 1�b7��Y� Ras. Comm 2 Project Ad.ress(not Mailing Address)or Road Name Space Zip 3 City/Community State Subdivision/Plat Name SP© t' �t _ Wfri G -i-i-- A2, P ltii/S 4 Assessor Parcel No. Lot Block r' �ciS1-4 -0 2-D 1 j * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage 7 Set Baont I(L)S-1 (R)S-2 ) I Rear Census Tract 1 Module No. Initials �// 7 N(0 (/11 * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name , Street Address . O(tdCI �{ DOC k .aZ2U Ai ( Ioi11 Zip G State Phone 20 7 ?Okkoe e.L1i1- ( SOS ) Z6 q6,0 7 Contact Person License No. \ C Phone if different than above 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 x Other ❑ Fire E Demo ❑ Add/Alter 0 Move 14 Describe Work � i 1 ; ) ROO i.- 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 DEPARTMENT APPROVALS w 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; ❑ Residential ss W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional struc ure; APPLICATION# / /��✓ Conditions/Comments: Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; ❑ Other Conditions/Comments: Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence; ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: El Other: ❑ Plan Exam Fire Prey. Conditions/Comments: c� Project Representative Telephone 0. Agencies Performing Special Inspection: g 1. Y o cad 7,5 ._ H E 2. in a LL.. 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold -.5.:ott..•.' /1?/5-4''•:_. __.. .. ...._..... ........... .. . ! 1 . . . , 1 i \i . ( ..... . _.... ( ..... ... ......... • • - . . -.• _.." , . „ 1 1 , : N . • . , I ; 1 1 i i , 1—• —T. _ i— _.L. ,..s, ; • N . I , ___i r N'- i i • . 1 I -- I t t , t Al ! f,P i . I ! L ! 1 el?(1 — . 4...9 ) 1 •x- * .kr'..--,—. •,,- ..‹."...- ',..- ••••••( >-•. >c -N,- -.N.,- ",..-- ''',..,-- 4‹:- --------< . . . , /„.• . ___