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1984, 07-17 Permit App 00001215 Siding, Fascia* BUILDING 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) a II (first) (m) Department Use Only Rea. IComm 2 Project Address (not Mailing Address) or Road Name • �•r44— 5 Sic Code Space ir Zip i Zone Act.* 6 Dwell* State Lk) Lot Block Zone No. of Buildings 7 Set Back -Front (L)S-1 * * * DEPARTMENT USE ONLY * * * Project No. Sq. Ft./Acre Census Tract Depth Module No. Frontage Initials 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Me Um i;m1-ors r�n�rr1 r)rsr Z-16„ City State s , vKct� u.; Contact Person License No. k-�r�.r�l'S 1'Y1�U�cta Im(.-A;11-Yt3- ($LJ tom e, Zip ggalD. Street Address iJ , 3itoC7 (aarA Phone �J ( 5q) Phone if different than above ( ) 8 Owner/Agent (If different than *1 above) 9 Zip 12 Review Required City Plan Check (Y! N ) Business Address State Other (YIN) Phone ( 1 SEPA Exempt (Y/N) Date 15 Type Work ❑ Bldg ❑ Flre ❑ MH ❑ Demo ❑ New ❑ Add/Alter ❑ Replace ❑ Move 14 pescribe Work 10 Applicant Name Street Address 11 Zip I City I State 1 Phone ( Lender Stree t Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 1...11.61A ', DEPARTMENT APPROVALS ❑ Application Type (Standard unless otherwise indicated) Fast Track This is not a Permit - (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ Early Start Release Release w/cond 1 i Hold 2 ❑ Environmental Health ❑ Commercial; ❑ Residential W. 1101 College ❑ New Construction; E Bldg alteration/addition Room 200 ❑ Additional structure; APPLICATION # Conditions/Comments• Planning/Zoning: ❑ Commercial; Cl Cert. of Exemption; E Frontage; N. 721 Jefferson E Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone; 0 CU, variance, zone change; shoreline; 0 fence; 0 Other Conditions/Comments- ❑ Engineers: ❑ Commercial; Cl Residential; ❑ Flood Plain; N. 811 Jefferson 0 drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments- Utilities: N. 811 Jefferson Conditions/Comments• ❑ Other: Plan Exam Fire Prev. Conditions/Comments: IInformation LJ 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