1985, 03-29 Permit App 00004704 RemodelET
4 BUILDING PERMIT APPLICATIONS WOF E FORMYOUUNDERSTAND
PLEASE PRINT AND COMPLETE ONLY THOSE
(Please return this original and your building plans to the Department of Building and Safety)
(first) (m) Department Use Only
1 Owner's Name (last) Comm -�
CiAnk Ras.
-riff PXG —.�f>!i�/� �-,nT/� �L'�%�0�ii{�✓v / Space Zip
2 Project AddressQ(not Mailingli/Address) as Road Name ��,
6 u 2 / `� 9'I SubdlvisionlPlat Name
3 City/Community State l� I� ll om np
* * * DEPARTMENT USE ONLY * * *
4 AMMO' Parcce! No.
5 Sic Code Zone Act. ft
Block
6 Dwell ff
No. of Buildings
' Project No. 7,e)
Sq. Ft./Acre Depth
7 Set Bads -Front
16 Architect Firm Name
1(L)S-1
l(R)S-2
Rear
Census Tract
Module No.
Frontage
m
Zip
CI
Contact Person
Contractor Firm Name
Zip
Contact Person
City
License No.
State
State
Street Address
Phone
( )
Phone if different than above
Street Address
Phone
( )
Phone If different than above
8 Owner/Agent (if different than 81 above)
9 Zip
12 Review Required
15 Type Work
City
State
Plan Check (YIN) 10tfler(Y1N)
Bldg
C Fire
14 Describe Work
10 Applicant Name
❑ MH
O Demo
IBusiness Address
Phone
SEPA Exempt (YIN)
❑ New
❑ Add/Alter
1414eory ItfAlv319PANv
ceRiK /nae/l
11 Zip City
qqz/2
Lender
1 State
C Replace
1� Move
Date
1 C Other
Street Address
XA2 iWA/
Phone ) ?2 y 232 3
I
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Additional Information
Conditions /Comments:
Utilities:
N. 811 Jefferson
Conditions /Comments:
Plan Exam
Fire Prev.
Conditions /Comments:
d.
Project Representative
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
Conditions /Comments:
DEPARTMENT APPROVALS
n* is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
Planning/Zoning: 0 Commercial;
0 Cert. of Exemption; 0 Fronta e•
N. 721 Jefferson 0 Setbacks; ❑ lot w/d; g
❑ lot size; ❑use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Comments:
Engineers: 0 Commercial;
N. 811 Jefferson 0 drainage
❑ road improvements
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
❑ fence;
Release
Release
w/cond 1
Hold 2
I I I
Agencies Performing Special Inspection:
1.
Telephone
2.
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold