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City of Anacortes <br /> Building Permit Application �^ r <br /> Site Address: B g ( I I S ST Parcel No.: S S J S 1 <br /> Lot: Block: Div: Addition: <br /> OWNER LENDER CONTRACTOR <br /> Name Name Name <br /> WV--N4et c 5.14. 4f¢ <br /> MailingAddress Mailing Address Mailing Address <br /> I v I t IS rim S-inao <br /> Ci : State: Zi : City: State: Zip: City: State: Zip: <br /> ACC& 1ta s t (Al A C1SU <br /> Roo -23- . -S.LEC <br /> Contractor Lic.No.: <br /> Phone No.: �,,J //��r�,,'• Phone No.:o./�� '�,, Phone No.: Exp Date: <br /> Contact Person: S A RAtuu' �/1 tm � 15,v Phone No.: 3,o-- 2�i 3- 44( S <br /> l OCCUPANTLL USE <br /> (Check One) <br /> Single Family: Multi-Family: Apartment: Condominimum: Senior Housing: Retail:_Office: Restaurant: <br /> Manufacturing: Storage: Bank: <br /> Assembly: Accessory: I/Automotive Repair: /�Other(Specify) <br /> DESCRIPTION OF WORK: 4 SAN.t-� Iv 0 SP Accesso 4U C �1LNlI, tT <br /> o g' l- <br /> o-F La t. I <br /> GENERAL INFORMATION <br /> Street Setback: ft. 2nd Floor: sf. (Circle YorN) <br /> 0 Side Setback: ft. 3rd Floor: sf. Shoreline/Wetlands Y N <br /> 2"d Side Setback: ft. Basement: sf. Water on/Adj.To Property Y N <br /> Rear Setback: ft. Occ.Group: Soils Report Y N <br /> Use Zone: Carport Area: sf Sensitive Area Y N <br /> Type of Construction: Garage Area: sf. Latecomers Agreement Y N <br /> Lot Area: sf. No.of Stories: Fire Hydrant(250 Feet) Y N <br /> No.of Dwellings: Building Height: Variance r� r—tr-.-V' l-sr^j <br /> Lot Coverage: Deck Area: sf. Covenant E D 1! l 1 j`,.13 L I j i a, <br /> la Floor sf Flood Zone lit l-,_:..--sA . "'- • Y <br /> 1 P S <br /> {Ii P:O <br /> Project Valuation(Labor and Material Cost): 1210 CIO- J� ! •g=', t'I I. 7 `��? 6`,` <br /> bil <br /> THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CO EI AlaiiiXk Ii..IrE 13Y LNWM'dTiON <br /> AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING hELSIDNA:.LIP•64 FfERBBreERTITYTl3AT I <br /> AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS 11 <br /> AND ORDINANCES GOVERNING THIS TYP '!O WILL BE C MP WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS' FOR INSPECTIONS. <br /> SIGNATURE: —� — DATE: Ili CO/ t --a7 <br /> t <br /> i5z l3 0 -7 - er51-k bce� a z - v3l Lid <br />