1984, 07-12 Permit App: 00001147 Soffit, FasciaBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety) '
1 Owneerr's Name (first) (m)
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Department Use Only
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2 Project Address (not Mailing Addr ) a Road Name Space Zip
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3 City/Community
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State
wA
Subdivision/Plat Name
4
r Parcel No.
Lot
Block
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* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. ft
Zone
Project No. ' I
6 Dwell X
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Bads -Front (L S-1
(R)S-2 j Rear
it
Census Tract
Module No.
Initials
16 Architect Firm Name ( Street Address
Zip
City
State
Phone
( )
Contact Person
Phone 11 different than above
( )
Contractor Firm Name
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rlors, MC.
Street Address
N . 310G ;4r--� on ne :Recta-
Zip
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City
S�OoRa-nom
State
wA
Phone
(50i) q-c9_s-44.62sco
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Contact Person
raft MGUG�u
License No.
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Phone If different than above
( • ) 5 e
8 Owner/Agent (if different than M1 hove)
Bus! ess Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (V/N)
Other (V/N) 1SEPA Exempt (YIN)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
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14 Describe Work
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10 Applicant Name
Street Address
11 Zip
City
State
Phone
( 1
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone II different than above
( )
Additional Information
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