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1986, 10-28 Permit App: 00013977 Duplex
t (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 /gall iii !! / Owner's Name LAST FIRST MI li d r L LL6%-& !.'i. Projecit Addres(%{Street Name & Number) j �- Zip S f/ % V- I/ 9 C -lh�C..J 9.7 Applicant Address City ��,, t /2�1 � -) State l,6)!,,2 l.6)Q J Zip ' �� /�'cmai Phone ) 9, ,9 c,2 , 9 ) Business Phone ( ) / Contractor/Agent N(') :),-)-6_—.- _L—yjl_K� Address s/� City State Zip Phone ( ) Contact // (-9 �q/ //License Number//(Required) "�.,G-L'e ..! i /LI N- A-1. Ci /2-1/07 M Business Phone �% ( )7--tl —.-- Architect/Engineer Address City State Zip Phone ( ) Contact• Business Phone ( ) Lender /c�� Add ess n �.d- /Lst!f )2/ Ci Y //// St Zip Phone � ,. • (;, � 'k �"'�i"' ""' 4 i9z, • i f ii011'Inl. /Plat Name/Start Plat t Assessor Paroei Number .` - d-- Si495 3 5 3 --,»9. 414, Lot kms` -6-Y-‘ Block ...? Plat Number Pestinent t=ile Numbers Zone Comp. Plan Census Tract Nurrta of £huetiing unite sgrC{ Number of Buildings ( Lot Size (Sq.�Ft./Acre) l /L/ / It / Depth . 140 Frontage I a0 Fiont 4 teff Setbat�t t �0 Right Setback 1 at Rear Setback R RAN Width AdClitiional Information 1 BUILDING INFORMATION I Square Footage Number of Bedrooms CO , - ft" Group -3 Type NI 1 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 to compile said application is true and correct. Signature laA X12[ecJ � L_f L%✓�/ Date / ,:,() PA_ Approved Cond. Approval Hold Environmental Health Application # / �^�1/'7 W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson Nn81neers�� 1 D N. 811 Jefferson Co\ 1 Utilities N. 811 Jefferson I Plan Revlew/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection information Protect 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 to compile said application is true and correct. Signature laA X12[ecJ � L_f L%✓�/ Date / ,:,() PA_ • ,d9 5/c /'//5 Do PAC i c. TF,2 //RTF "g." 95' 4.111•011111 .011111/M11.1111111•••MIM /DO©L.'• DoA L �' 4t61,1 aurS f=i'NI isN F.oc,r,. s= 3z - S. Crt1c•. A PP 07i F 1 Iv X/6, nL- /'/11IS/I . FL oo Y• T S, 8L/4 . i'; TawNE,e 5 Apo 8!7 0440 14 ST•. Carla. f PnrJ Lcrf' /3414. 7 AJNE,2S qDD. Ssk, 519 c wi,t sr. L.i/I t� • 0 't eLe PLa r+n3Ei Y"/b'.C.,r syS4, Asrin 0-3o3q-so-3. CAPPED ENDS.