1986, 10-28 Permit App: 00013985 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)
Project Number
�I+�5
Owner's Name LAST FIRST MI
LU 01—F4/9V/ -
Project Address (Street Name & Number) Zip
S. 9/? '-aO i14Lui'A) .S t. 99.2 J•
Applicant
tuD1_LA.,un Ro-
Address
S. 7/7 iodes Al
City
_Spo,4/Le-
State
WA .
Zip
99;1--o4
Phone
5 9) 9.2,c? -,75-k2)
Business Phone
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
V,t,vice &e,'pp
License Number (Required)
Li) oI-rI 41J1/v -23m
Business Phone
( ) 9ai —c,2 3-9,;U
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
R/9//e---S/7141X es J2 7 IGC/4/
Address
City
Stare
I Zip
Phone
(
iNerk
Res.
Comm.
!Plat Name/$hart Plat Number,
60»Je,e ,4W r`ar4)
Pkat Number
/3/42..4.5 -"Is - .
Lot S
J aver
Buck
1
Plat Number
# Fite Nutters
Zone
Comp. Plan
Census Tract
Numt of [!welting Units
Numberof Buildings
Lot Size (Sq. Ft./Acre)
z 90
Depth !{
Frontage
Front Setback 4
Left Setback
Co `
Right Setback %
5
Rear Set
R / W Wide
th
Addtt i lntormation
z
0
4
2
ce
Q
u.
zes
z
O
5
OD
Square Footage
Number of Bedrooms
Buftdtng Tiician
Crate �y Q/,,
I tS "' I/8 69
Group 2
Type
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 applicatio
is true and correct.
Signature
Date
/62%7*
Approved
Cond.Hold
Approval
Environmental Health
W. 1101 College
Room 200
Application #
7
_ 7-y
Planning/Zoning
N. 721 Jefferson
Engineers N. 811 JeffersonE:A9T:
) C -G
Utilities
N. 811 Jefferson
I
Plan Review/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 applicatio
is true and correct.
Signature
Date
/62%7*
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