1986, 07-02 Permit App: 00011953 Residencer,
(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)
SHADED
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lititis
Owner's Name LAST FIRST MI
kaki L -A -TS <ftr t N r.H rs Wfri Q m4
Pr ect Address (Street N me & Number)
A -s r PED2 Ave 94206
le K
Applicant
_ligiti 4i6s
Address
go20/ e 8'
CitState
a
OWL
Zip
99037
Phone
(5a5 ) 472 i 3-5 X.
Business Phone
Contractor/Agent/l..
LYt
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
Architect/ Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
— -
City
State
Zip
Phone
Describe Work,':.
K r of OCE ` sY/GA'rkC
Res.
..Comm.: :,.r.
,Subdivision/Plat Name/ Short Plat Number
".1 .. . a1 ACPES'17M. aPL-.4-'i
-Assessor Parcel Number O.'' p
; fot y't..'(U(1- -- {;q:.
-�f '
;Block'-.. .' "r'
Plat Number.. .
Y•
Pertinent File Numbers -. .
, �� �
'Zone? ,i
//yam/-,�� '�V
'.Lot
=Comp! Plan? f .:._ . ,
?CensusTract='- -^ 'v`•
; .. ..
Number of Dwelling Units
d.. .,
'Front
Number,of Buildingsy.''
I.
Size (Sq.Ft./Acre)',F•-
., -
Depth --
~;
Frontage', M1.
.:,'., :
Setback
•ro=
Left Setback.=
.. ..
Right Setback) .,, -. .^
Rear Setback:-. -
R/WWidtht}:-'_: .:..a
Additional Information
-Square
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µ�.:.�s.:';.:,,.BUILDING'INFOfl�MAT10N�r�-'� ��„�''��
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Foota a
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232. .GAR
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,li, 'Y�y t'..,`,�i''
. _- .. `s`!. . ;. -:"4_1;:= 'b[ r.'�'.',r _;-
` '"
Number of Bedrooms-
# _:.,.. ; -_,. e11
Building Tec 'clan'
Date
7-227•436.,
_
4Group """"'•._:.Type.'".
DEPARTMENTAL REVIEW
I certify that 1 have examined this application and state that the information contained in it and submitted
by me or my ag• n to compile said appljcation Is true and correct.
Date 7/2
Approved
Cond.ci/ Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
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/CU —0 7 7 O
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A.y
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,Planning /toning
N. 721 Jefferson
/
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( Engineers
N. 811 Jefferson �w� H.V -C.:41)
a
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
7-5- Fri:,
lie
Other (SEPA/CritIcal Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
I
Phorie
Address
I certify that 1 have examined this application and state that the information contained in it and submitted
by me or my ag• n to compile said appljcation Is true and correct.
Date 7/2
: ,
-7 -1 +
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