1985, 06-24 Permit App: 00006068 Reroof, Enclose BreezewayBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return thls original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Department Use Only
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2 Project Address (not Mailing Address) a Road Name Space Zip
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3 City/Community
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State
_
Subdivision/Plat
(
Name
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4 Assessor Parcel No.
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I
Lot
Block
+ . + DEPARTMENT USE ONLY * * *
5 SIc Code
Zone Act. I/
Zone i/ j c&
Project No.
6 Dwell /I
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front I (L)5-1
(R)S-2 I Rear
Census Tract I Module No.
Initials
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16 Architect Firm Name I Street Address
Zip
City
State
Phone
1 1
Contact Person
Phone If different than above
Contractor Firm Name
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6roterr,.re_
Street Address A,'
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IWt 4 4
Zip
9"9" At, 6
City
SperArrn e
State
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Phone
(s& 9) to -.z 7 Z 6
Confect Person,License
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No. -
Bis,vr 77 A7/-
Phone i1 different than above
( )
8 Owner/Agent (If different than p1 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA Exempt (YIN)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
❑ Move
0 Other
14 Describe Work
Re—(SOF 4 .NGcic/NCo 7Z
10 Applicant Name
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information d 0
42,00