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1986, 06-03 Permit App: 00011373 Addition
(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) or invw pncno..nr_ rvn vcrrtn i rvicn i..L voc rProlect Numoery. y ;r,;,,� Owner' ame LAST FIRST MI c /T/de,eSOVe9 Project Address (S reel Name & Number) ,.,,//,�//� AA 9r5/2 -- /13423 /Cie a 57— � Ff ge- / / i/ Applicant !!!! ADDlipnt Address4% City State Zip Phone Business Phone ' Conlr or Agent o%2/ACS,' 67,45 f Add ess 4/1)/ %%ye/e ei/E AV City 3-PoI'd 01.J -e State 1.04/ Zip 9'9,1/_ Phone ( ) y76-iai2. Contact License Number (Required) Business Phone Architect/Engineer Address City State Zip Phone Contact Business Phone Lender Address City State I Zip Phone ( ) Describe Work; it :,. 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L:.,eY 4�Aa t.-w:,i Y{: /D �' • ry 't,y' �'li .1 �. '•-.i. .l: S � 'Vy'.yi�'... .' rs'+, " ::4eiti:,+..}i S�/L'`��T{': �'A>"l�.....t..~7., .•!{a"t''i..+-:•-s.. )^.'`:';rq,}•x;a.-s;'°ii1` Y.,rh'i• .. .. ..' MM -1 rT's.:�.: r<Snr`.. y` hi�'1..✓> ' Il:: c- 1iaa!. y-.•:td? .'t:..,, •,:`.•.: ,1. .,�' . =:�`A:',-"-v/,_y"f.='_'`b,�.`_"5 r�jfy�-�'+(2 y •.:•:.ti.:r_.sK y-{'Y��S."•' • 14 , 4 'y ±�•1_. v a y_ -ScF tea +>? • ;C ... iYY/.. "" "S�-',gR:amySv."ry;'',}- _:". -4 k. .. _.: .r ti". a,`<�" •t.Vr,.� 3:Y,V,_4.��`.[- iYi��ACc. xtt4;�-.9.yc:x'�f4.$)-.3u',jei£�1.•+ 'qi'),'y�,•.,F”.!._�.n.t`{-.'',,•�. -.,.� • i...- , , i' -;, ..-- 4 ;. ?•y --.K: ..,' - -�»r.o, t .1?-- . • T�✓�. v �r : "'. _:e., 'S^; :;a'::r:r"„'. 4y,•;y;4,.:j' �� - Y r`'.:i...n ..' 4j r� 4.:,"�`. C: .. :`•'Y#": - r.. .:hS. '- �,:31.ir:.. r_ . yK+•n<ain�'.._ ., Ma u_ ., - .. .;.. �(n n- _ .,ya.>i ay.:y ;."ca? e•.l+t �v. ` . V ::. . .i..jM „+.K14. ..�rtrtn'. :'-D� %:. -.x?.._2,(.' .F. 3',' y1i'',>^` t.S'V u�i�yi •�.4 ?axSei'1s'+o-v.SlC`.13..'i:a^ y`F.:. et �:: .k �w �.z,k-"cis cg9`-4`kTxasa4 r:"{�` .;a•7ti" .titii,c,v,{"^'<.rY`;.ty==-" ---.:ti r.,-.,#.e:xr..,y--�'.,,-, 3 } f,�, :ate ' 4�i-p: zsn ;S ,ryex 'i.,. ar ``'• '43 r.. =li�Zw ^: x.fy..pi`+i,y-ST«_+t ��.��!!C.t'i;;��{{7'F,�t`'"T`� "-. �8� t.�)�� 3 . <,,• e ' .. t' %✓E J� Y"Sftl`Sa�-y :y{,yyry•A:L` Y{U'.-'_is'+•i,i�xl'tt'>•iN.?4. ' C.`'%'•.':' ii. ; �. ,�j�''++ r Numberof Bedrooms,,. •. ty� thc._45i•Ca.''-{w'- �.'>) X 1 �' Ml Sic - .: 4... •Bulltlinq�T 'clank. r �' ' .y.i}2' il Date ys:.'yZ: i :: r.,V n -A.-- T.":..•? ti•' � :t.:: x_Y`5a'. Ysy . i s3.c Group'.•3.'£Y_--•— :T- YPe :``�'Y -v Iv c; y'; Environmental Health W.1101 College Room 200 DEPARTMENTAL REVIEW Application # I S-39— Approved "' Approved Cond. Approval pik Hold Planning/Zoning ❑ N. 721 Jefferson Engineers ❑ N.811 Jefferson Utilities ❑ N.811 Jefferson Plan Review/Fire Prevention, ❑ N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special inspection Information Project 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 lead2a Date 1 111 1 1 'a8-1:3:; t0.73 .(