1986, 07-01 Permit App: 00011919 Reside•
(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 DEPARTM ENTAL USE
-.S
ProIt Number':
Owner's Name LAST r FIRST MI
4✓
Project Address (Street Name R Number)
Zip
S . /5o 7 Co ol ,, to 6C- 99037
Applicant // -
go L[ 7 • incLJ
Address
.S• /5-07 �n uit-,c, t o l�t�
City o
ViAadae-c—
State
WA-
Zip
99o37
Phone
e(Sd)9.;_8-94,//2
yy 3-y
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V//4. - nitg
Business Phone
1 1
Contractor/Agent
77/e/Oetti taxa
Add
77.3/o
ass
. # - , ,-
City
I State Zip
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Phone ��)9.2-y- / p
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Contact
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License License Number ;Required)
McuAYBc 31/4,1)1E
3usiness Phone
(1a-47t4—�
Architect/Engineer
Address
City
State
Zip
Pnone
t. )
Contact,
Business Phone
(
Lender
Address
City
State 1 Zip
Phone
)
Describe Wor �• '. +'
(g � ,.rs .> ._.�/
Comm.
Subdrvlston/PIat,Name l f tat Number •
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`Assessor Parcel Number .a ; " e -:i'.: ,
rr
ax t 2 if et-. 3163
Lot
3
Block -
PIat Number
Per'tnent File Numbers "� .;s '? "{.
�r t '
Zone
SFr-c_Camp.
Plan -
.Census l'ract-
Number of DwellingUnits a` -
t
Number of Buildings
Lot Size (Sq. Ft /Acre)
/3500
Depth
Frontage
Front Setback
Left Setback -
Right Setback 9
Rear Setback ..
Rik!!! Width
Addition al Information y3,, x,
Ua�f
ti dx� -
9_
�/9 5 6
BUILDINGINFORMATION ' _'�
Square Footage
q
� � r CO l 3
.S're4.5aTd-FA 'L`fbY�irtl''.i7i? ,.Y ..+ '7•{ .. "'.�
f
-
f yiiV +d'T' 1
Number of Bedrooms
G'
Building Technkian "' r .n
Date
Graup 1 Type _