HomeMy WebLinkAbout1986, 01-03 Permit App 00009308 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
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 U iOnly
rc .r) C S Lo Lt. t 5re_, (� -
Pas. �f
I
Comm
2 Project Address (not Mailing Address) or Road Name ' ; Space Zip
N . 51 Z ELLa — q q.Z12
3 City/Community
Soo k a� __
1 State
A
ivision!Plat Name
Su�1Qc.A.JGTD N `S OD TO I-) ti Tyr- : A (Sts,
4 Assessor Parcel / ` L
!� `�. J ---
Lot
(Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
Project No. q,7 6'.e,
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
l (L)S-1
(R)S-2
Rear
I
Census Tract
Module No.
Initials
16 Architect Firm Name I
Street Address
Zip
City
_.
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firrn Name
MGUcH 6� ¢rs Gon-&aCID (3 7 c.
I Street Address
,-1, 3IC& A-23 0 7n-- %hoc
Zip
96I.212-
City 1
Spokak�_
State
v ,2t
Phone
(5"Cq ) 6%2?- q(‘,�.
Contact Person
/4:2 rf-7 / MC U 011./
License No.
At c 0 P Y R C 344, tr2 E
Phone if different than above
( 562-)v,-._-E...—
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
`
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (YIN) I
SEPA Exempt (YIN)
Date
15 Type Work ❑ Bldg
0 Fire
❑ MH
0 Demo
0 New
❑ Add/Alter
0 Replace
0 Move
jZ( Other
X-',.- 00� r
14 Describe Work
._57-.e e_ 1 S! , ..So CiL' P Sce a__,_
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
Va. bL ca ficy-) - �_ 7 / q, cc
o..e,c h-u:-/- ree - 47, ov pi,(..-.. z/ . 6c — ii ? , 5o
DEPARTMENT APPROVALS
❑
❑
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
I I Iits IS IWE a rermit
(Indicated approvals required in either "release" or "release with conditions'
space prior to permit issuance.)
Release
Release
w/cond 1
Held 2
❑
Environmental Health 0 Commercial; ❑ Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
APPLICATION #
Conditions/Comments-
❑
Planning/Zoning: 0 Commercial; ❑ Cert. of Exemption; 0 Frontage;
N.721 Jefferson 0 Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments:
•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811 Jefferson 0 0 0
drainage new access/approach; fence;
❑ road improvements
Conditions/Comments-
•
Utilities:
N. 811 Jefferson
Conditions/Comments
❑
Other:
❑
Plan Exam
Fire Prev.
Conditions/Comments-
Project Representative Telephone
0
Agencies Performing Special Inspection:
1
E
`c
2
C
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold