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1984, 09-17 Permit App: 00002309 Enclosing CarportBUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND'COM,PLETE,ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name '���jj (lastj (/ � /C, ?'(first) (m) DepaRrrlent Use Only Flea. Comm 2 Project Address (not Mailing Address) or Road Name Space Zip 3 City/Community O State Subdivision/ Plat Name 4 r Parcel:No. c .: Lot i,Bfock ,t * • DEPARTMENT USE ONLY 5 Sic Code Z6ne Act. # Zone Project No. 6 Dwell # No. of Buildings Sq. Ft./Acre Depth Frontage 7 Set Back -Front (L)S-1 (R)S-2 Rear Census Tract Module No. Initials 16 Architect Firm Name ' Street Address Zip GtyState Phone Contact Person •' Phone if different than above Contractor Firm Name Street Address Zip - Gty State Phone Contact PersonLicense No. Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State - Phone 12 'Review Required Plan Check (YIN) .. Other,(Y/N) ". SEPA Exempt (YIN) Date 15 Type Work ❑' Bldg_ ❑ Fire ❑ MH ❑ Demo ',❑ New 'Add/Alter ❑ Replace ❑ Move ❑ Other 14 Describe Work 10 Applicant Name klo Street Address/ 11 Zip City © /9 `✓ State (� Phone (&? g) Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above Additional Information _ m /� cu ��