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1985, 05-22 Permit App: 00005643 Residence 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 Owner's Na c (last) (first) (m) Department Use Only 4 p 55-7-C t—i n 5 / Res' Comm 2 Project Address(not Mailing Address)or Road Name Space Zip 'off a,2© 3 (-1-t-' 3 City/ munity State / �!^ Subdivisio lat Name q L-1--e--2 �,t Ci�� `�e bi , rim,.. C/ / /��/�L--t�C eiS4 Assessor Parcel N Lot Block ZZ5 �- /�O� -I , * * * DEPARTMENT USE ONLY * * * V�.J / �NYZ�5 Sic Code Zone Act.N Zone I� t No. ��4. 6 Dwell# No.of Buildings /{/J� Sq.Ft./Acre Depth Frontage / I /5/ 86 7 Set Back-Front� I(L)S-1� (R)S-2 l Rear Census Tract I Module No. Initials c%C9 * 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contr r Firm Name Street Address )2 Z aty zplState Phone (1/6),'") Contact Person License No. Phone if different than above ( ) 9s8--990->( 8 Owner/Agent(if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(YIN) SEPA Exempt(Y/N) Date 15 Type Work "1-31g ❑ MHIVew 0 Replace 0 Other ire ❑ Demo .&--.4 ❑\Add/Alter 0 Move 14 Describe Work G-% L�1491 10 Applicant Name Street Address 11 Zip City State ' Phone ( ) * Lender Street Address * Zip City State Phone ( ) Contact Person Phone if different than above ( ) 1Additional Information g�0 4 L, Cv (r- cam. • • 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.) ❑ Fast Track ❑ Early Start Release Release w/cond 1 Hold 2 ❑ J Environmental Health ❑ Commercial; ❑ Residential 6`2-`/ O'er W.1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure; APPLICATION# Conditions/Comments: LI 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; S((7( N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; Q�? ❑ road improvements Conditions/Comments: ❑ Utilities: N.811 Jefferson Conditions/Comments: Other: ❑ Plan Exam Fire Prey. Conditions/Comments: coa .70 -23- Project Representative Telephone o. Agencies Performing Special Inspection: O c 1. U '- R E 2 c, o L c u_ 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold • i- ._ I - e ..., ele ` . (cist .e. I - - ,- t A z.,s5 , f 1) "- I _ � — 1Z oZZD - 1 . . is 4 L orz c4 Qom- �r-to,.`.- \t . '' . O'S 7"/C0 7 1 • AL"----� t , - `'. - -cam ___ -3. 1: 4,6 /A ' ' 0 ; . .s _Cviie-() 1.: --4-e • j-_pts AL -. V -6_o,) 611 3it-o" / . . Tre-3i.--- /Of I I) ii 15 11/ -----13.-rlitePr.11-16) *Ipl ,P.- er--. .. • scyrr,s . s i Jr, . , .., 4 .,,,i, ot„, , ,_ .., 7 — • ' "45-18'S,I. • MA. PVC S4-15---r41', ,,,„4P . , , ' S Tit', 30341 8641 Erc; ; .o p =y-i- - - - sfasY 13A___5 __i) -,:„ 1 1, ...., . .I- , ____________ _ . . 0--:-.,,,,_„-_,A_ . ., - ''- moo' -