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1985, 04-11 Permit App: 00004950 Residence i ,. 2 / b t . BUILDING PERMIT APPLICATION WORKSHEET 0, 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 Name (last) ( (first) (m) Department ly ��srll J S` IO:rhV c.),Rn R33. Comm 2 Project Address(not Mailing Address)or Road Name Spate Zip 1 1405 r=. D: r( t781 3 City/Community State Subdivision/Plat Name Dawe_ \� o.. �,re? ..CN iamO 4 Parcel No. Lott Block a813 — 33\ S \ 3 * * * DEPARTMENT USE ONLY * *55 Sic Code Zone Act.N Zone ject No. s `., 6 Dwell N No.of Buildings -Sq.Ft./Acre Depth 9V l Frontage 7 Set Bads �t 1(L)S-1 (R)S-2I Rear Census Tract 1 Module No. Initials 5 5 * 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) J Contractor Firm Name Street Address Sa.rc-21 Zip City State Phone ( ) Contact Person License No. Phone If different than above ( ) 8 Owner/Agent(if different than#1 above) Business Address S a m Q.. S 30 l..‘:(1c.©\v.., 1;76\ ,..cL. 9 Zip C_ily State Phone q°1 ao\ qo V.z.c\_ VI 0, (so q) -71-4)- LI 12 Review Required Plan Check(Y/N) Other(YIN) [SEPA Exempt(Y/N) Date 15 Type Work B""Bldg 0 MH 11,--New 0 Replace ❑ Other ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move 14 Describe Work reS is/PNCC eLti/C`�-<`C�0-c 10 Applicant Name Street Address • 11 Zip City State Phone gga.o 10 Sgt.:DV.ar -e _ o.-• (5O°1 ) qa.c;S — 1a3 S Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information r : 1-8O-� co« d , U3 /300 ..2._ i , c_ r\-)----- , 'Z i X32 ry C1 . ..ate p ^ - DEPARTMEN,T APPROVALS 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 Rele-�_- w/cond 1 Hold 2 • Environmental Health ❑ Commercial; ❑ Residential ¢ 4�, !`� IM W.1101 College ❑ New Construction; IDAi Bldg alteration/addition F/ l MEM {� Room 200 ❑ Additional structure; `. . APPLICATION# 676-'7— O (4( (--p ry 3 l )tib i--i?- Conditions/Comments: h ,AA, ,r../ A....-1 di " �/("� ��L Cj / 1 - I % ❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; 0 fence; ❑ Other Conditions/Comments: Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain; LW N.811 Jefferson ❑ drainage Elnew access/approach; 0 fence; ❑ road improvements Conditions/Comments: /%///- /f'd ❑ Utilities: N.811 Jefferson Conditions/Comments: ❑ Other: --- 4 ❑ Plan Exam m Fire Prev. / Conditions/Comments: C c m Project Representative a Telephone a) Agencies Performing Special Inspection: co _. C 1. T. Ti •- H E 2. ro o CS c 3. 1 Indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold Q4, - - - ;i , _,,I€A474 � , . 'irt/lb-71 -11 5/ . - -5 ' 1\1 . 11\ A 4 NNt Y , \\ ki j t441 a. 1 1*— cl ‘4 k41 .7-d--- nat,gt, 84,1 to e -. G r5eci ,,e 5 -7, Alicr 141 1 k 0 t v, w, 3 �' k Al 1,% ‘ , A 41 a -Xov t t1 ,