HomeMy WebLinkAbout1984, 05-30 Permit App: 00000403 Reroof, Skylights• BUILDING 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 Owner's Name (last) (first) (m)
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Department Use Only
Ns.
Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
—/ /-5-76 /=/I/Pb'iEG/t/ I i' 2O 6
3 City/Community
S,,o .2 i4 NE-
State
A
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. 0
Zone
Project No.
is
6 Dwell if
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' I
If
Ac
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name ` 1,271/�
I— i
/ l j
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone If different than above
( )
8 Owner/Agent (If different than 01 abov_et,� I
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/ N) I SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
:A Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
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10 Applicant Name
3flI176-S G. i4 -7D 'Foe
Street Address
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11 Zip
9 j oZ 4' 6
City
SF'dilff N c
State
W A
Phone
( ) 9-2 9/ 2 7
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
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