1984, 10-01 Permit App: 00002562 Addition 00
"' BUILDING PERMIT APPLICATION WORKSHEET 18w
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)
1nees Name (last) (first) (m) Department Use Only
W 8 6— 2e l, 608 FEs. Comm
2 Project Address(not Mailing Address)or d Name Space Zip
ibS'oL 61 .;-`11-h
3 City/Community State Subdivisi n/Plat Name
SPOK14ti w� ��
61465 6®//.s
4 Assessor Parcel Qs fil— C2g4Lot 1 Blocks /T
Ly * ,t * DEPARTMENT USE ONLY ,t
5 Sic Code Zone Act.# Zone Project No. 2 5
coo 20,
r! G.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
r Z _ irrPyu/ur
7 Set Back-Front I(L)S,r-1� (R)S-2 Reeaar Census Tract Module No. Initials 911Ze
4 j
* 16 Architect Firm Name Street Address
SA L&i2 Gay 7`: //yd �
6 3d7� c
Zip City State Phone
Contact Person Phone different than above
J/h7 Sc/e� ( )
Contractor Firm Name Street Address
S L e Caws C/717/6 6 3k7eit,
Zip„. Cit5pox/9/ State v/a . Phone ) 9 P P‘9e
Contact Person License No. Phoneif different than above
—07//// Sq/� e ,1, 23-0 / .0/45-'9 ( )
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 P.""gidg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo Idd/Alter ❑ Move
14 Describe Work �i
Ckb7 ioii ""o teSic%'1 e e, Q2e #/
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
t
DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
r
❑ Fast Track
❑ Early Start Release
_ Release w/cond 1 Hold 2
<5.1,ek
Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure; �U,�'' '' 'j�J'
APPLICATION# �'_-J! / ill
/�' a y// Q' a
Conditions/Comments: f _h'e .Gr ( "j 'S „c/., ' ,,1< ,
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ,
D CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain; I
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam -.2,-ty
Fire Prev. i//d/�'y
Conditions/Comments:
a
a)
c
-- Project Representative Telephone
as Agencies Performing Special Inspection:
Y O
c 1.
U '—
f0
h E 2.
o
f° c
LL
3.
1 indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold