FANCHER N 1220 NW ROLLING MILLS REBUILD
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BUIIDING PERWT APPLICATION WORKSHEET
PLEASE PAINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this original and your bultding plans to the Department of Buildilig and Safety)
~
1 Owno►'e Nem9 (flsst) (first) tm1 OeW ment U9e Only ~
,T ~ I ihl'_ S, 1 Qo ~Ll N~ ~ 1 1IC F186• ~ Comm ~
2ddrees (nd Mallin9 Addresa) or Road Narne SPace Zip
n1 ~A AJr~ P~ State Subdivision! Plat Name
3 GtylCommunity S
Lk 1=.
. qsyeeao~l No. Lot Blxk
(-n, t DEPARTMENT USE ONLY w w+►
~ L. t
5 Sic code Ione Att. N Zone Project No.
g pwell N No. of Bufldings Sq. Ft.lACre Depth Frontage
1.
7 Set 8acic-Frant (L)S-1 (R)3-2 Rear Gbnsus Tract Module No. Initlals
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* 18 ArChitect Firm Name Street Address
21p Gty State Phone
1 )
ContW Peroon ' Phone li different than above
( )
Gbntractor Firm Name Street Address
E (a 9 a0 T)P
p qty State Phone
q a Z 1 Z s ~ o kA ~-.e kiJAsL• (60~ ' 03 L/
ContW pwwn Llcenaa No. Phone if different than above
~
( )
y 3 V\P% 2 C
8 OwnBrJAgent (if ditferent thgn ftt abave) Business Address
g Zip City Stete Phone
( 1
12 Review Requlred Plen Check (Y/N) Other (YIN) SEPA Exempt (Y1N) Oate 1111111110011111111111 ~.S -r
15 Type Work ta/81dg O MH C New 00 Replace ~C Other
G Fire C Demo AddlAlter C] Move
14 ribe Work
c- ~n1~47•AT L DN ze6
' 4PL m ~
' 10 Appltcent Name Street Address
11 Zjp City State Phone
l ) "
* 1, L
Lendet Street Addres9
Zip City State Phone
( )
Contact Pe►son Phone if di(ferent than above
Addltional I nformation
"7 N
a~
o%' • ~ ~
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DEPARTMENT APPROVALS
~ This is not a Permit
Application Type =
(Standard unless (Indicaled approvals reyuirad in either "release" or "release with conditions"
otherwise fndicated) space prfor to permit issuance.) ,
~ ; Fast Track '
; I Early Start Release ~
Release wlcond 1 Hold 2
; L? 4 ~
~ Environmental Health C. Commercial; C; ResideMial
W. 1101 College O New Construction; 1-7 Bidg alterationladdition J
Room 200 0 Additional structure; `
APPLICATION #i
Conditions/Comments:
,
vl,~~ ° ~ C i...~► r~ C~i 3~h t S i o~.. :(✓f
0
Plannfng/Zoning: ❑ Commerclal; O Certv . of Exemptlon; Cl Frontage; ~
N. 721 Jefferson CI Setbacks; ❑ lot wld; ❑ lot slze; 0 useltone;
D CU, variance, Zone change; shoreline; 0 fence;
• O Othe
Conditionsl Comments: (3 r- fS k1 t '-TT 6Y-)
~ Engineers: ~ Q Commercial; 0 Residentlal; 0 Flood Plain;
'.N. 811 Jefferson O drainage Cl new accesslapproach; O fence;
❑ raad improvements
' Conditions/Comments: ~ Utilities:
N. 811 Jefferson
Condttions / Comments:
C3 Other:
,
~
0 Plan Exam ;
Fire Prev.
Conditions I Camments:
a
~
c° Project Representative Telephone
a Agencles Performing Special Inspection:
N c
Jc o
0
ro ~
E
o 2
;
tv c
LL
3.
1 Indicate ebove or attach condltlons ralative to final as bulit approval
2 Indlcate above or attach reaaons for hold
f w
i ,
:ontact k'ersUtt Nama~/h, liubiness Na~ne~j , -
,~BY..~
Addcese~. ~ Address /y ~
Phone lllr_~ "vy Phone
County Contact Person_~.6 ~~~5 Q/~ Phune No. 456-36UU ,
CUMMEktCIAL fiU[LULNG PEtZMi'!' KEVtEW
This buildYng permit review is intended to appraise you of the impruvementb (roadway, side-
welk, curb, stormwater, etc.) which must be constructed in association with your building
permit. This checklist will be f i lled out by the Engineer's staf f and a copy will be re-
turned to you at the time that the permit is initialed by the Engineering I3epartment. All
requiremenLS shall be completed prior to issuance of the building permit. All unchecked
boxee require additional research or information to make a determination.
1. Stormwater Draina e Coneiderations
A. per gueT~nes for "Stormwater Management 1981" both on and olYes site.
1. 208 Considerations* Li No
2. Flood hazard zone considerations** ~ e s ~ No
3. Storm Drainage Plan es ~ No
Ix. Plannino Action #
1. Rezone, Conditional Use or Variance on property Li Yes No
2. Are requirementa of planning ac[ion incorporated Li Yes ~ No
into eite plan
III. !jjht of iJay
1. Does permit necessitate R.O.W. dedication Li Yes VNO
2. Dd.d zone change require R.O.W. dedication Li Yes t?( No
3. Radiue at corner Li Yes VNo
IV. County Road Improvemen[e
1. Roads need to be improved. How wide Li Yes ~ No
2. Curb Li Yes ~ No
3. CRP/RID agreement (Copy of deed, contract, or Li Yes ~ No
title report required.)
4. Plans for improvemente provided Li Yes o
5. Side walk ~ Yes ;/No
V. Parking Plan 6 Approach Location
1. Review and sign off by TrafEic v
es ti o
2. Approach Permit from Engineer's Office ~ Yes No
3. State or Ci ty sign of f ~ Yes No
4. Is this road oi1 6 Year Plan ~ Yes No
VI, ULID Agreement: ~ Yes ~ No
VII. r'ield Review: !'reliminary Coinments
00V
* All 1at1d w1Chi+i it►e Ac~~jirer Sensitlve Ar'ea, wl»Ce deeme-d ft!,jsit,lt~ hy C1~~! U~~~~~iLy h.iigi-
neec, shal Z incorpvrdtt! St'ot'mwater treatment tn mi r.tKate t.lie pot.-enr i.a I to~r grolil►.1a.1(01
degraciat ion. ( tiee t;tr i<ieI t nes for SLo~rmwat. tr Manat;einen t 1981, 5~)ok.iiie Ho.j rci ot C:4,1111t v
(:omm-i tisL' oner' s kes,► llit ion No. 80-1 59 2, ,Iti .flmendetf.)
Illl'_ pI1C pt-tiv i} f th Uwd h.1 ~•I CCt /rllte t"I'V l f'W l ti tO l171. il l llll >l' ~~l~tilti ~+11~• t lo~,Jl lli~ l ll •'~j)l'-
r i.fic arNati ciPti i t'• , hv h'1 ood Ila .~ard fiotindary on f i Il. ir 1I14. H:ngiti~.or' S
tlrF tCt.. (So_e ;ip.)k.ille• B,)1t"d -tif t,Utiilt}' Z.elftitfiltiSlt)Ilef'~s
I
.
' DEPARTMENT APPROVALS
This is not a Permit
Applicatlon Type
(Standard unless (Indicated approvals requlred In either "release" or 'release with condittons°
otherwise Indicated) space prtor to permit Issuance.)
~ Fast Track
~ Eariy Start Reiease w/ceond 1 Hold 2
'
J-
'
Environmentt~l Healfh O Commerclaf; ❑ Res)dential A~x
W. 1101 College 0 New Construction; D 81dg aiteration/addition Room 200 ❑ Additfonai atructure;
APPLICATION M
~ % 1) .
Conditions/Comments: Vl ~ ~ ~ -
. , L ,
~
Ptanning/Zoning: O Commerciaf; O Cert. of Exemption; O Frontage;
N. 721 Jefferson O Setbacks; O lot wid; O lot size; O use/zone;
O CU, variance, zone change; shoreline; O fence;
O Othe Canditions/Comments: =c ~~6~ PLAf,3 f
(
,
~ Engineers: O Commercial; ❑ Residential; ❑ Flood Plaln; 1~ ~
N. 811 Jefferson O drainage 0 new accesslapproach; O fence;
O road improvements
Condltions/Comments:
~ Utitities:
N. 811 Jefferson Conditions/Comments: ~ Othar:
❑ Plan Exam '
Ftre Prev.
Condltions/Comments: a
Project Representative Telephone
U
a Agencles Performing Special Inspection:
Y O 1'
~ ~ .
~
~ E
2.
~ c
LL _
3.
1 IndEcate above or attach conQitlons reletive to final aa built approval
2 Indlr.ete above or attech reasona for hofd
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PR,INT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this or(ginal and your buliding plans to the Department of Building and Safety)
~
1 owner's Name pest) (tirst) (m) oepartment uee only ~
1~! l..Ll N~ l'' C pas• ~ Comm 01
2 ject Addreaa (not Malling Address) ar FZoed Name SPace ZiP
122Q F-A AJ_C g 2K_
3 Gty/Canmunity Stnte SubdivlsionlPiat Name
S, p KA N„Q w A~~ 0E1L-,- 4-lC~ 6z.. N` S
4 Pwwl No. Lot Block
rt w~t
s ,t DEPARTMENT USE ONLY
5 Sic Oode •'Zone Act. N Zorte r6t ProJect No.
2
g Dwell N ~ No. of Bulldinga Sq. Ft./Acre Depth Frontage
T J
7 Set Bedc-Front - (L~S-i (R)S-2 Reer Qamus Tract Module No. Inltlals
* 16 Architect Firtn Name Street Address ~
Z{p qty State Phone
( 1
Contact Pereon Phone if different than above
( )
- Gbntrwtor Flrm Name Street Addresa
t.4...%,N ce mk 1c ~ 4o96-7
Np aN st8te Pnone
Ia Z1 Z, ~ pok-A M-e (60A 03L1 ~
(aontact peropn Ucenae Mo. Phone I( dlfferent than abave '
V\00%% (Si A 2 6-
8 Owner/Agent (if dlfferent than 01 ebove) Business Address
9 Zip • Gry. State - Phone
. . , ~ )
12 'Review Required Pign CheCk (Y/N) ' Other (YIN) ~ SEPA Exempt (Y/N) Date
15 Type Work t;/Btdg O MH ❑ New (D10 Replace 0 Other
0 Fire O Oemo O Add/AHer O Move
14 DeAcr Work
' " - C ~LpO~ Ekl'S~ IfUC~ ~v.NDATL10 N
" P
Street Address
' 10 Applicant Neme WU
i 11 Zip Clty State Phone
4 •
Lertder Street Address
Zlp City State Phone
( 1
Contect Person Phone if di(terent than above
Addltional Intormation
~ - 2 ~N