Thierman N 1015 Farmers Union Central Exchange
T
BUILDING PERNit1' APPLICATION WORKSHEET
PLEASE PRlNT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND A
(Please return this original and your building plans to the Department of Buflding and Satety)
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1 Owner's Name (last) (iirst) (m) pap,ar~ment Use Only
Fh 'r~lE'►' T f~~l,eo i~~`~,tJ~v'.y ~ ~k'f ~;;v.'v~'r F~•~~ Comm
? Project Address (not Mailu,y 4ddress) a Roed Name SPac@ ZiP
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3 City/Community State ~ Subdivlsion/Plat Name
J 6. P/ v~ f ~ O~v
4Asses,gor Parcel No. Lot Block
13 S 3&f ~4& ! x, i*+ DEPARTMEh'T USE ONLY ♦ w~
5 :Dwell e Zon~ Zone ~ Project No.
6 No. oi Buildings Sq Ft.lAcre Depth Frontage
~n 7 c-Front (L)S-1 (R)S-2 Hear Qensus Tract Module No. Inltials
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* 16 Architect Firm Name Street Address ~
Zip qty State Phone
( )
Contact Person Phone I( different than above
( )
Contractor Flrm Name Street Address
Zip Gty State Plione
( )
Contact Person License Mo. Phone if different than above
( 1
8 Owner/Agent (if different than 01 above) Busl ess Address
y ~~BQx J~a6s ~
s z;p crtY State Phone d 7PiG F' - S~ y- o y~ 4
q`l S/o ft ; 9~-1- -v Sr z.
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12 Review Requiret! Plan Check (Y/N) Other (YIN) SEPA Exempt (YlN) Date
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15 Type Work Bldg . MH rD New 0 Replace r`l Other '
2~ x ~Ao ~ Fire n pemo r, AddlAlter O Move
14 Osscri/b~e Work f~~'1
1 Ofici.iT ~i~ r C~. ► • ` ~ . ~ .
10 Applicant Name Street Address
11 Zip City State Phone
( )
* Lender Street Address *
Zip Gity State Phone
( )
Contact Person Phone i} dit(erent than abave
( 1
Additi Ilnformatfon
Fas~ S06 /V W~ 25
i
DEPARTMENT APPROVALS ~
This is not a Permit r
Apptication Type
(Standard unless (Indicated approvals requlred in either "release" or "release with conditio(is"
otherwise indicated) space prior to permit issuance. ) ~---a
Fast Track
Earl y Start Release
Release w/cond 1 ~ Hold 2 ~
`-J Envlronmental Health (-1 Commercial; Residential
W. 1101 College CJ New Construction; f; Bldg alterationladdition
Room 200 ❑ Additional structure;
V.,#-- Zl/l ?
_ ~
APPLICATION # ~
Conditions/Commgnts: A~7i
7/f
Plenning/2oning: U Commercial; L~ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson O Setbacks; ❑ lot wld; ❑ lot size; 0 usel2one;
O CU, variance, zone change; shoreline; O fence;
❑ Olther .
ConditionslComments:
~ Engtneers: [7 Commercial; C7 Residential; O Flood Plain;
N. 811 Jefferson 0 drainage L7 new access/approach; O fence; ~
Cl road improvements
Conditions/Comments: •
0 Utllltlea:
N. 811 Jefferson ,
ConditlonslComments: F] Other:
❑ Plan Exam
Fire Prev.
Conditions! Comments:
a
c° Project Representative Telephone
n Agencies Performing Special Inspection:
U)
~ c 1,
Y O `
U Z
M
2. -
~ `c
U_ _
3. - -
1 Indlcate above or attach condltlons relatlve to tlnal aa bullt approval
2 Indlcate above or attach reasons lor hold