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1986, 10-01 Permit App: 00013792 Residence
(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 AREAS ARE FOR DEPARTMENTAL USE Owner's Project Number 7') �' Name LAST FIRST MI SIC 7 , Project Address (Street Name & Number) ZEAs r 13308 �E oy Ay ;e .. Applicant Address City State Zip Phone ( ) Business Phone ( ) Contractor/Ag geent (-7 Address 7' `' ; x -y wG City (/`)d P Le r ..41/0.41e State 2'z Zip_ r'J --.3 8-W Phone ( ) Contact Architect /Engineer License Number (Required) //Ii - / i ' Business Phone (x C ir ) . 6'6"' 2 04.•3, Address City State Zip Phone ( ) Contact Business Phone Lender City Address State I Zip Phone s k bB Wodc - , 3 +` r [ ii -r7 14 / r�S J,(tjr Gtr ^/4r/eV' p Res. �-''� Comm. . \YI• 1 (L r t Lkt� Lot � Block j Plat Number 1• Fire Numbers Zone.. ..-R ,F Comp. Plan Census Tract of Dwelling Units Number of Buildings 1 Lot Size (Sq. Ft./Acre) Depth /IOC Frontage 76 Left Setback Right Setback Rear Setback RI W Width Square Footage Elle ltd Z jC Sl(© LIME o P. a ' 2 cr O /2 rI • - {L z e, .yy� t� J J` '^ m Number of Bedrooms BuildingTechn - ; - D//atter . ( r _ ma / — /o Group r_-3 Type VNO 0 et. DEPARTMENTAL REVIEW I certify that I have examined this application and state that the Information contained in it and submitted by me or my agent to compile said application Is true and correct. Signature( Date Cond. Approval Hold Environmental Health Application # o -7//-2,-Approv O G - ��_,111 .1/4 '� aO .. W. 1101 College Room 200 - - �� rov- /1, A- a , �t`17f� b"ee� d Planning/Zoning N. 721 Jefferson Engineers �Jh t--- 811 Jefferson -7//d/ �3 U Sfl.N. Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson 10-2-3'"(O (/_L)" Other (SEPA/CrItical Material/etc.) Fast Track/Special Inspection Information Protect Representative 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 to compile said application Is true and correct. Signature( Date ." A sr, jJ C(04 - ..Z• - .•-•••-•-• GA" afr Vaitie 0 -r - • . c c 77. 5`7.2 ' • - •:- • 96.o,