1984, 08-24 Permit App: 00001928 Siding, Soffit, Fasciac8UILDING PERMIT APPLICATION WORKSHEET.
PLEASE PAINT 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)
.^(leap (first) (m) °� Department Use Only .
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Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
tCnr-{-h i103 Edcier-f qg j c _
3 qty/Community
kap_
State
LOA
Subdivision/Plat Name
4 Aesesson Parml No.
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 SICCode'
ZoneAct. f
Zone
Project No. 19 n
(/
8 Dwelif
No. of Bull ings
Sq. Ft./Acre
Depth
Frontage
7 Set Bads -Front '
(L 8-1
(R)S-2 I Rear
4
Census Tract
Module No.
Initials
18 Architect Firm Name I Street Address
Zip -
qty
State
Phone
( 1
Contact Person
Phone If different than above
( )
Contractor Firm Name.Street
I
kr l/ t rc4ers CC-'t-raChorsI TAnc.
Address
�r 310(n onyt e �cxtd
Zip
6161.2-I
qty
SpoKr, 1.—_
State
WA
Phone '
LSoq l 9g -iii Sec
Contac Person
I-zu rl$c-n /TV Aka/
License No.
MC -v/1 Y6 6 3 lYIE
Phone if different than above
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8 Owner/Agent (if different than e1 above)
Susi ess Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (YIN)
Other (Y/ N) ISEPA Exempt (Y/N)
Data•
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
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%
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14 Describe
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Work
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10 Applicant Name •
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
( 1
Additional Information ' - O
—
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Ptrm+ Fee — (01-