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1985, 08-02 Permit App: 00007376 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) Jr7AUtU AtitAJ Atft rUti UtrAN 1 M tP1 1 AL UJt I r Project Number / 37 G / r Owner's Name LAST FIRST MI M`' to i24-^tT L1 M • C IA I:. Project Address (Street Name & Number)/ Zi r, 3OOZ t) c--kc0 91 L` ,3S©� --0. c1! p Applicant S tI m e Address � 4(o2-4- S• \j fa j r /tfrN rz._TEQ City o1c A r1/4.X State Zip Qa—C2G Phone (6Cet ) a— �c-� Business Phone ( ) Contractor/Agent • Address City State Zip Phone ( 1 Contact License Number (Required) i C-r2a Fri Q ZS- 2.DC. Business Phone ( 1 Architect /Engineer Address City State Zip Phone ( 1 Contact Business Phone ( • ) Lender Address City State Zip 1 Phone f Describe Work (T-i.ej 10E n)4 -i!•5 LV i 6 VI YL faitE7G, +:.:-'r-rc Res. ✓. Comm. Subdivision/ Plat Name/Short Plat Number 0I-zC._c-\1.'kc2J) !Au E NAL€ Assessor Parcel Number e:)- it —3Ca b 4.11111 V" -N p F .1A—Cr Lot 413 Block Plat Number Pertinent File Numbers Zone A:1:4 . • s Comp. Plan Census Tract Number of Dwelling Units I Number of Buildings I Lot Size (Sq. Ft./Acre) Depth Idi(. Frontage I o5 Front Setback1 Left Setback Right Setback Rear Setback Additional information 4-z1.00 DEPARTMENT USE Square Footage /e3-1 mF 1 S 6.2e ea..LFt: 3 1 - co 3O0 ea -2 A43). 5v 1 C C4. c,t DFC.g Building Technician e an Date Group 12 Type DEPARTMENTAL REVIEW / Cond. Approval Hol d Environmental Health Permit W. 1101 College Room 200 Number l°/Approved �Z e lZ 1 Planning/Zoning N. 721 Jefferson -5-4- )3 C 6 p a� & & - ct' " 5 cs . e- 7 ac .j r `er4..- i -e t� ev . / . gyp -L ac / r /1-n5 3 .. 4, 3 o Q L iJ'TC a cr m orrru CG40-Az_cr-e-Tt"T� /4,P174. -(C A -r (v(.) �r#c�r.✓3 e7T#te7Z[ttr Gui'rel tN 7I+F FrLL _ f%vC4 i' Y4FLfa ti{LFSr- S Sr -lee ant /)fZ 7 C ' Cti el e e H r LI iii. 'f (-, I2 e---#1-r-&---7t_ . l'`,2Fi 'T /5 '. 7 S ' peAet I - Wet.? L,/y Engineers Permit '`' r N. 811 Jefferson 0.,i t% i. c4..)j Number — 9 f� 5 v r i '././V -A",::5-.177 Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson - c- b '- Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Protect Representative I 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 is true, correct, legal, a d bindin4C<ra*6 Owner's Signatu Legal Description 512C44120 AQS Aoo ‘,46e.' ?e 9'r""a' I iL —t Scale. Date: /2.145 Revisions• -r- - -- - r. rt 1 L �j - 0'o'- 1 1 1 J4' 1 Show on Site Plan: Additional Information: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark a Legal Description 512C44120 AQS Aoo ‘,46e.' ?e 9'r""a' I iL —t Scale. Date: /2.145 Revisions• -r- - -- - r. rt 1 L �j - 0'o'- 1 1 1 J4' 1