TRENT E 6206 DIAMOND LUMBER
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; BUILDING PERMIT APPLICATION WORKSHEET
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, PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
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; (Please return this original and your building plans to the Department of Building and Safety)
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1 1 OMrner'a Name (Isst) (Ilrst) (m) Dgpartment Use Only
'D rAqA,vu D L v m(~ ez 6C->M pAA! K Comm ✓
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2 "eC1 Addrem (not Meillnp Add►ew) v qpaQ NBme SpaCe Zip
( 3 Gty/(bmmunlty 8tate SubdivlsionlPlat Name
~Po K.. A ~J i1.c1 ~S /f . C "t~ L N~n rz E~ cz 1 ~
4 Asemeor ft►oel No Lot Block
1 Z S~~~~~ G~ ♦ t,t DEPARTMENT USE ONLV * w t
~ g Sk Oode Zorse Act.11 Zone Pro)ect No.
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g pwell • No. ot Bultdln9a Sq. Ft.lAcre Depth Frontage
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7 8e1 Badc-Front (l)&1 (R)S2 Renr • eua Trect omodule No. Initlals
18 Archltect firm IVame Strget Address #
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Z)p pry Stete Phone
Oontecl Pe►eon Phone if different than abave
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OoMractor F1rm Name Street Add►ees
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~ 21p lpry Stete Rhone
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Contact Peroon llCenee No. Phone If different than above
R06 V, Z4 `1G~ (4,14DA&Z-
8 Owner/Agent (if different than 01 ebovet Busfness Address
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9 Zlp City State Phone
12 Revlew Required Plan Gheck (YIN) Other (YlN) SEPA Exempt (YIN) Oate
15 Type Work Bldg / MH O New ` 1 Replace .'~i Other
❑ Fire Lp pemo 'AddlAlter -1 Move
14 Describe Work ,
A ~D) T~ ~ 1~~ vhU ~~L S R~S R R~ f~-
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10 Applicant Name Street Address
11 Zip City State Phone
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• -
Lender Street Address ~
Zip City State Phone
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Conlact Person Phone ii di((erent than above
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Additional Intormation~j
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DEPARTMENT APPROVALS
This is not a Permit
Appllcation 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 wlcond 1 Hold 2
Envlronmental Health O Commerclal; 0 Resldentiat
W. 1101 College p New Construction; ri Bidg alterationladditfon
Room 200 ❑ Addit{onal structure;
APPLICATION R
Condltlons/Commentr. _1~1~i✓~ / . ~(/y~ %j~~~~ ~
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Plenninp/Zonlnp: D Commercriai; O Cert. of Exemption; O Frontage;
N. 721 Jefteroon O Setbacks; O lot w/d; D lot size; O uselzone;
CU, verlance, tone change; shoreline; O tence;
O Other
Conditlons / Comments:
~ Englneoro: O Commerclai; O Residential; ❑ Flood Plain;
N. 811 Jefferaon D drainage O new access/approach; O fence; ~
O road Improvements
Conditions/Comments:
Utilities:
N. 811 Jefferson
Conditlons/Comments:
L/
~ Other:
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~ Plan Exam
Fire Prev.
Condittons/Comments:
a
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ProJect Representatfve Telephone
~a Agencies Performing Special Inspection:
~ c 1,
Y O
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2.
1° c
LL _
3.
1 Indicate ebove or attach conditlons relative to flnal as bullt epprovel
2 Indicate above or attach reasons tor hold