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1984, 08-30 Permit App 00002032 AdditionBUILDING 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 my 1t ,/� /JJ / 1 L7G-C 2" Ras. I Comm 2 Project Address (not Mailing Address) or Road Name Space Zip 3 City/Community 5 /0©/i-.4 State c _.5- Subd vision/Plat Name -15 5 13 4 Assessor Parcel No. -2-254- i _ /..2_4- .# 1 Lot / Block I �_ it �r . DEPARTMENT USE ONLY it* * 5 Sic Code Zone Act. Zone /� /,�( I�� Project No. 6 Dwell # y No. of Buildings Z.-140S Sq. Ft./Acre Depth Frontag 7I 7 Set Back -Front (L S-1 Ltd 1 (R)S-2 Rear Census Tract Module No. 16 Architect Firm Name Street Address Zip City State Phone Contact Person Phone if different than above ( ) Contractor Firm Name 0 (i 4/ ;- / Street Address Zip City I State Phone ( ) Contact Person License No. Phone if different than above ( ) 8 Owner/Agent (if different than #1 above) 5 )4 r3? C-- Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (YIN) Yss Other YIN) NE5 SEPA FYPn rt (YIN) Date 15 Type Work ❑ Bldg 0 Fire 0 MH 0 Demo 0 New Add/Alter 0 Replace 0 Move 0 Other 14 Describe Work Z 0 x 2 7 .0 reeTee % 34c {li 0',,011 o z't , eS ,e Lj c7 y5 0 X 10 Applicant Name Street Address 11 Zip ,.2'2- C City sP��A7"7� State vf�s7` � Phone ( ) 2z - 5.___ 0 ? Lender e._—_____. Street Address Zip City State Phone ( ) Contact Person Phone if different than above 1 1 Additional Information Application Type (Standard unless otherwise indicated) Fast Track Early Start Environmental Health W. 1101 College Room 200 DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ Commercial; lM Residential ❑ New Construction; ❑ Bldg alteration/addition Additional structure; APPLICATION # Release,? Release w/cond 1 Hold 2 " Conditions /Comments; Planning/Zoning: 0 Commercial; ❑ Cert. of Exemption; ❑ Frontage; N.721 Jefferson 0 Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; O Other Conditions/Comments Engineers: 0 Commercial; ❑ Residential; N. 811 Jefferson ❑ drainage 0 new access/approach; O road improvements Conditions/Cornments• ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions/ Comments• 171 Other: Plan Exam Fire Prev. Conditions /Comments• 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 fjj I 5- o /0 0 v • /1,1; „_„/ i