Loading...
1986, 10-28 Permit App: 00013979 Duplex1 ' (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 (Project Number ,eorq Owner's Name /� LAST FIRST MI / 7�( (/(JlZ, � / Projectddress treet Name & Number) Zip 9G' 4`6J C� =-t�� �% Applicant L.i CC' ti --)2 - Address . �y��/ �� it_e.:7 k -f City (4eil-z.e._.-) State Zyt_}a ZipPhone Q';, 6 ( ) 4f -,3_59,_2.., Business Phone Contractor/Agent Address ' City State Zip Phone ( ) Conta99t - , \ / License Number (Required) Business Phone Architect/Engineer / Address City State Zip Phone ( ) Conte& Business Phone ( ) Lender ///� //�� 7'L GL - 4- 4-e. /%%/-/ Address City State Zip Phone • . .l'� i/ ,..1,4 VI. Comm. : .. F /Plat Name/ShortiNumber r r /f if .. .l Assessor Parcel Number ....236 .<4.4 — t..54/0 7 3W3 -- .9 0 Lot 146 9\4 /0 Block Plat Number Pertinent File Numbers Zone Comp. Plan Census Tract Number of ow ling Units Number of Buil ings Lot Size (Sq. Ft. /Acre) 1slat 'a/ Depth 1 f40 Frontage Rd` Front Setbecic i Left Setback t Right Setbacks y Rear Setback R/W Width Additional information Square Footage Z O F= 4 2 O u. Z Cf z 0 .a Z fp Number of Bedrooms Technician (i 0'1 Date i 0_ Group -12- 3 Type IQ 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 /v Date j7/f4 Approved CpApproval Hold Environmental Health Application # W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson En ineersl l! ,, N. 811 Jefferson Eos 1 -Q `� W c_:, • Utilities N. 811 Jefferson I Pian Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Speclal 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 compile said application is true and correct. Signature /v Date j7/f4 • . • - 4i95/c /415 DoP1.6-7( .6 02 5, Js' Ili 1`,1 /000 L. • OVAL rt 4. ti 71.. S." • 3 3- r oft Lett,' r.e...c" it I. t' • A 1)t., A Dots fti...e 1/"''.C. 097 AsTin 0 -303q-so. C PPE° -AIDS. LOT, 7azdPER.5 9•3. caz.vijI 9©I AO TjIBZJ&re; e.4)NE.EQS 41DD. 1512:1 *re cm.vd .5r. Lo 674 3