1985, 09-04 Permit: 00007227 ResidenceJATU EO`P
OWNER OR AGENT
^y7?:239D AV
7r.S./ ASSOCIATES INC
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^°14 E 2::3RD AV
9..T6KANE =WA `'"\,9;),06
171f7./ ASSOCIATES INC
Energy Studies Surcharge $10.00
��=�= BOX 14084
�TUKANE "`'WA z'"'9214
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01+401 RESIDENCE W/GARACE
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41°54>DT7ef"sti: 23RD AV
STRUCTURAL
Building Code Fee
Energy Studies Surcharge
BUILDING
Valuation; Curr 60177
4 of Floors 01 # of Bedrooms 000
PRIMARY STRUCTURE:
Desc; N DWELL Croup: R-3
Sq -Ft 1396 Occupancy Load
SECONDARY STRUCTURES:
Desc; N DWELLUB Croup: R-3
So -Ft 1038Occupancy Loa
Desc; N PRT CAR WE Group: M-1
Su -Ft 484 Occupancy Load
APPLICATION /1,7
DATE /
"E" *:~
0q0/865
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09/04/85
,="°.
00007227
BUIiDINC $370.00
Building Code Fee $1.50
Energy Studies Surcharge $10.00
~"= $381.50
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CA
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CG
NC
COUNTER AP,
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TOTAL FEE
TOTAL FEE
TOTAL FEE
Permit Fee
4 of Rooms 000
Type: VN
Rate 35.50 Valuation
Type: VN
Rate 6.50 Valuation
Type: VN
Kate 8,00 Valuation
49558
6747
3872
$1,50
$18.O0
$370.00
370.00
O9-04-85 466,95 *5.=5O.zu
OFFICE COPY
(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 DEPARTMENTAL USE
IProject Number
Owner's Name
Project Address (Street Name & Number)
LAST FIRST MI
//-SS-C3 C .-i' j /iG% e—
Zip
/:37 / 3r0 /2//e--/
Applicant
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City
State
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Zip
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Address
Phone
(
Business Phone
(
)7-2-2,-
Contractor/Agent
City
Contact
State
A4C-!%R:'E
Architect/Engineer
Zip
/
License Number (Required)
S 4f
Address
/St voev
Phone
Business Phone
(
Address
) 92-1 , C; %d
City
State Zip
Phone
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature Date
Cond.Approval
Hold
Environmental Health Permit Number X /Q00
v.. _ g;
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers ,,/rL/T
N. 811 Jefferson ,/1 £ 'V
-(______
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
-
/Keil
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature Date
i ' i I I + ( ( '
Show on Site Plan: Additional Information: I ' , { '
Lot Dimensions Landscaping
Existing Structures Drainage Plan ,
Proposed Improvements Hydrants ,
Structure Setbacks Topography
Easements Lighting _ j
Septic System(s) Signage
Water Lines Shorelines
Sewer Lines Highwater Mark f ;
Fences,Wells �
Driveway(s)
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Right of Way Width(s) j -
Names of .
Fronting Street I
Flanking Street —
-
Legal Description {
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Date: l1 1..._ __ {._ f
Revisions: Attachments:
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