1985, 10-16 Permit App: 00008109 Finish Basement(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)
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Project Number
I
Owner's Name LAST FIRST MI
-E 7142 1E S 1)A-0 D 4r,
Project Address (Street Name & Number) Zip
I 11 Ci 7 0 Q S Q.� VG -2ND ALC- tOA- 99 0 3 7
Applicant
NO ‘b LOAD io, JE`4 .IES
Address
S .1 109 3ofz,5 r2.b ,
City
0 2--
State
wA -
Zi
b3-7
Phone
( ) 9Z(,) --)do
Business Phone 1 Z 4 T
Contractor /Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( )
Contact.
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
Cesa ibe Work
rn T F(NI544
Rea. V
corm.
Subdivision/Plat Name/Short Plat Number
Sre4C)PI' Icier
Assessor Parcel Number
314 S-063
Lot
Block
2 -
Plat Number
Pertinent File Numbers
Zones
Comp, Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
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1 BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
JUIN
m -
bete
-k
Group
_
R-3
Type
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DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my age to compile said aygpliction is tr and correct.
Signature
/d Date
Approved
CpApproval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
•
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 age to compile said aygpliction is tr and correct.
Signature
/d Date