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1985, 08-02 Permit App 00006315 Residence, GarageBUILDING PERMIT APPLICATION WORKSHEET 2) 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) Usip.6niy 'Department r nn �INIGH. c rQ[Ov1 - Comm 2 Project Address (not MailingAddress)or Road Name n Space Zip 5 ,o 2JS Dt-75- -wood Cz- 3 City/Community 5/00)(g..1..Q,` .-_ State (-Jr.- Supctivision/Plat Name n (� C`''OI"cL�tr-o 3 g- �--( �t:LCX . Qlit:44:1- 4 Assessor Parcel No. 32 S 'T./ — /9// - Lot 1 Block * * * DEPARTMENT USE ONLY ,t 5 Sic Code Zone Act. # Zone 'SF 12- Project No. ! / (p3i i2 6 Dwell 0 i No. of Buildings i Sq. Ft./Acre Depth 14-& • Frontage , (-71 7 Set Back -Front `moo` (L S-1 _ t l� (R)S-2 Rear _ , j Census Tract Module No. ( Ini ' s `'" ' 16 Architect Firm Name Street Address Zip VVV City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Gordlvt-, T IMc- /4 meS Street Address N 5rv6) /Th.//a. t Zip ?' 20.6 City Spb 1.- w� State c,� _ Phone ( ) I215 — 7043 Contact Person G60-A� TInG4 L No. fiiNtCft(' 2Gj PF 2z3�1 Phone If different than above ( )icense 8 Owner/Agent (if different than #1 above) Business Address 9 Zip r City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) • SEPA Exempt (YIN) Date 15 Type Work ❑ Bldg Alto 5t4, /, Fowl. pi,4) , ❑ Fire ❑ MH ❑ Demo X New ❑ Add/Alter ❑ Replace ❑ Move ❑ Other 14 Describe Work / D r'r. �{ 4R `G •[ 10 Applicant Name Street Address 11 Zip City State Phone ( ) Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information ( F (S l 06 - [s1( ‘frYt = 1( v Application Type (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) LyJ Environmental Health W. 1101 College Room 200 Conditions/Comments D Commercial; tiv residential ❑ New Construction; ❑ Bldg alteration/addition ❑ Additional structure; APPLICATION # C 0 7-3 Release Release w/cond 1 Hold 2 v Planning/Zoning: ❑ Commercial; 0 Cert. of Exemption; ❑ Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; O Other Conditions/Comments- Engineers: ❑ Commercial; ❑ sidential; N. 811 Jefferson ❑ drainage new access/approach; ❑ road improvements Conditions/Comments /Y✓/r'- 37r D Flood Plain 0 fence; Utilities: N. 811 Jefferson Conditions/Com ments• Other: Plan Exam Fire Prev. Condi tlons /Com men is• 5 Project Representative Telephone Agencies Performing Special Inspection: 1 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold j.../° BSc. zit<)44" • I, t4jd'i4if 45"