Loading...
1985, 02-25 Permit App: 00004285 Addition• 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) (first), (m) Department Use Only 1 p n V"CtlstVQrvP A0 2 RS . Comm 2 Project Address (not Mailingg Address) Road Name Space Zip 0 ' L1 � J fr 3 CIty/Community State Subdivision/Plat Name 4 Assessor Parcel No. Lot BIock * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zone Project No. Or 6 Dwell # No. of Buildings Sq. Ft./Acre Depth Frontage 7 Set Back -Front I (L)S-1 (R)S-2 rear Cnsus Tract Module No. Initial'ir16 Architt Flrm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name Street Address Zip City State Phone ( ) Contact Person License No. Phone If different than above ( ) 8 Owner/Agent (If different than #1 above) Business Address 9 Zip City State Phone ( 12 Review Required Plan Check (Y/N) Other (Y/N) 1SEPA Exempt (YIN) Date 15 Type Work $ 0 Bldg Fire 0 MH 0 Demo 0 New 0 Add/Alter , 0 Replace 0 Move ❑ Other 14 Describe Work ADP' e -A Wm (4 Y 16 10 Applicant Name bpN E- i 5- tit( r360& -r D NS Street s Address 11 O, 0)` 11 Zip City State Phone Lender Street Address ' Zip City State Phone ( Contact Person Phone if different than above ( ) Additional Information 2.. 98 134 s‘a - i213,;,..-- A-pornoi,•e --T---.' •••_.• • .•, - • . ••, • • I• 3 • 8' . • rieLD A-..,-.: , ` - ,...- '...- . $'• • , :. . ...- , -,-"''' '''' "5'-..-",''',-.': • - .--; : '.- '..,A,. *1,,,--, . - .'• - .._ ' '..-?•C • \ ^ - Fi...`. .. '-'"."'-‘,.:•-•-• , , -, 7-. ,..,--..-.„,.--- . .- , - - ---4:,:'..- -. . - (-,-..---'--, . i 4•::." • 2- : t-.1 - 'r ;''''''',' '' - ' ; '. ' .•••• ' ••••: ' - • ..• ' - ..3Z;• -•°Z.,,;:. ,''''' ' • - • „...:-%x .... ' __,..7:•‘.'-' '' . " '''- ;'"'. ' _. ••••• . . - •'''i',- •,-,- ., - .:-- . ,••• •••- y* ' ' '• - . . ._ • . • - - ..- • • • - . 7--•• .., • .7 • 7 • ...c. -. •-- . , „. - '.-, ' _ ,.•:::.•:- ': '. . • „,,_., _ ,•,,fuv . .,,, ..,t., ....,.,..,,, ... :°-....,.,'„,.': ,.4, . ".q.; --'r-••,1: ' .:('-•.:,,".: • , ' - • ..” • -i.. ..,,,,,,,,„„ '' : ' .-----;e4-&-.7 -- ity,cof ..___iv.:,,,4Z1"S1...-4 -:,JT41___,..—._. _ , . ,.. . ,-.•„ , - - 4 .4g.:;•h •;-.5 .•'.. At dr ;,1, , - . • • • --Z( ' • , .; • • - - • • • — • - _ • - ; ' - - -;`; • fV'r. - r • •:." • - • . ' • . • ' - • ' •-•;.= , • • • -: 741. ; ... •• - • ••-- •7.•; _.•:;?frZfi "t,a ; :C••1•S'e- , . , •••'7,•••!`•••;_`..- •:•Ar