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1986, 10-15 Permit App: 00013915 Duplex(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 I Project Number lows' Owner's Name LAST FIRST MI I,rJo.CckAN7) (O, Project Address (Street Name & Number) Zip ,I, 2/2 1- ,?(;. CALv,A) ST 992/6 Applicant &ON. Fh .44).2, e o • Address S- 7/7 /i`A/es ,d City ,Spok4Ne State IVA. Zip 94706 Phone ( 675 ) 96?6e-76—gZi Business Phone ( ) seiy},-2---' Contractor/Agent / t oZAZA d Jz Co Address City State Zip Phone ( ) Contact V i, 2J Se /'p,o License Number (Required) 1,00i-P4e * /zia �.a) Business Phone ( 9 ) 221,_..-.2....„4-2_____,2-} Architect/Engineer Address City State Zip Phone ( ) Contact 10 Business Phone ( ) Lender —3:411/ es 4/3-4 es MO • / FHA Address City State I Zip Phone Work OAS T; 04) BG r 4's. Cbu,A/e,r✓ Res. / �f Comm. divislattPiat Name/Short Wet Number l(,)Cti.Qe.5 d �Q% wD Ataessor Parcel Number Lot,S Block Plat Number Perim ertt File Numbers Zone Comp. Plan Census Tract Number of Dwelling Units Number of Buildings / Lot Size (Sq. Ft./ Acre) /"V/ 'X90 ' Depth ) + i`{ 1 Frontage c 0 l Front Setback Left Setback 6 Right Setback Rear Setback RI W Width Additional information I BUILDING INFORMATION Square Footage Number of Bedrooms Buil ing Tecrniciart Date 10—Ic- 9G. Group 12- 3 TYpe v&$ 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 co pile said application is trund correct. Signature Date AV/06 • n� Approved Cond. Approval Hold Environmental Health Application # � /��1 �� � t i�� �L W. 1101 College 9 Room 200 #1-4-71-11 il /..04, ' Planning/Zoning N. 721 Jefferson Engineers N. 811 J% fferso ar/i.:., / - i� e ,_ /�� 1Y2� . ' Piffl i = ' /� / '/ ' v%t /% ,j �i Gt / i:„:4111103!" fe2 ! gm/ �C / • ` L Utilities N. 811 Jefferson I Plan Review/Fire Prevention N. 811 Jefferson 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 to co pile said application is trund correct. Signature Date AV/06 0 ,Q.QSic /'f/S WL T-0.'2 /SW TC - 0 Pi- "1 44.77) 3S' 35J1 3 Cz cn/7 a u T'S c�htsr+ rc,2. /OdO �iAL OCJAL +ri -�.61 - b E� A ewe rP13 y/1.C.in- 2?5 .57/77 c -3o341 -6D - ~Q PPE° c41)�5. • Lora 84X.T©4JNEe5 ADO 6. q� 'c0,14 '..sr. ,20 L. ; t3zg. / TaWNE,eS q©©. . ,1 CALL / 3 T. /Ale 41,1444 eI )1444