1986, 10-07 Permit App: 00013492 Reroof(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR D
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'Project Number q!f'7
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Owner's Name LAST FIRST MI f
/h / E .17r9 d qugS
Project Address (Street Name & Number) Zip
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Applicant
/e)L L" 7-•usuL 14-7--/ 4 /t) v-- 600 r_ 7 ,t)6,
Address
City
=SPO
State
i1C)r-t
Zip
G'q O2
Phone
(509) 535«Sj23
Business Phone
( 1
Contractor/Agent
Address
City
State
Zip
Phone
( 1
Contact
License Number (Required)
RE.=N)StttLe, , lJ
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
s :ti
rest oeE
Res.67
Comm.
«a !Shot plat Number "
ASaisaorParcef Nutnher
J
Lot
Block
Plat Number
.ie -
Zone
Comp. Plan
Census Tract
;i!ittl►tf s pweIIIngUnits
Number of Buildings
Lot Size (Sq< Ft. / Acre)
Depth
Frontage
Left Setback
Right Setback
Rear Setback
R/W Width
y0Square
z
Q
Footage
rFt3�A2^g
VG INFORM
a
m
#�?.
Number Of Bedrooms
fes-
fhF
Date
,6_7-86
Group
tz3
Type
DEPARTMENTAL REVIEW
I certify that 1 have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date is - 1, SCP
Approved
Cond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Pian Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
Phone
Address
I certify that 1 have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date is - 1, SCP