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1986, 03-13 Permit App: 00010282 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) JrlHUCu Hr1CHJ Hrtm r'Urt uCr i r1 I IVICIN 1 HL UJC Owner's Name LAST FIRST MI C KJN \ l.- Cv.o rg.0 t^ ( o rr51. . 1 hc_. Project Address (Street Name & Number) Zip s z o I^r1 N e k_ Applicant C�Ak c.....,_4"N LO �� Address /U (8)Q (�li�fehou 5 Ci � � � State cAk�s�. Zip g ga�� Phone (SOS) YG 7-ffO?7 Business Phone Contractor/Agent S�.1•••t° Address City State Zip Phone ( ) Contact License Number (Required) 1 ►t- lit 234Qos) . Business Phone _ ( ) Architect /Engineer ! ! /,r inn `e . Address (S)tt City State Zip Phone ( ) Contact Business Phone ( ) Lender Se& f 1 RSt. 01 o Ng_/y;6c! Address 6©( Z:oefeTriP. City CiYAt State / f S Zip l Phone Describe 4.i (k'')(,%'16`12Pr&E Res. Comm. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number ' `) t-. Lot Block Plat Number Pertinent File Numbers Zon- Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./Acre) Depth 77 Frontage �7.T1 Front Setback Left Setback Right Setback 2, Z R�r Setbecfc S \ R/ W Width Additional Information j -.-1S. VA tikh VAL4 '/ IBUILDING INFORMATION Square Footage O 41,m r 34/ to F.E. (5.60 s cre ?c t "-> Rcc ittv60 3/! t/ 1zb Pc e. -/- 52g5 9'4 4 n-- Number of Bedrooms Building Technician Date 17-c#R.karra ri-h KIS ln_iij Gr up_ s.._ - V N! DEPARTMENTAL REVIEW 1 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. Signatur 1L-eAy(-- Date O)42,e,4 ild24 Approved Cond. Approval Hold Environmental Health Application M'r w%c Sta W. 1101 Colleget�� Room 200 16-71-4:-.16i /Y----k-zt /W14-11.-‘" Planning/Zoning N. 721 Jefferson Engineers g 7Z." e 7� N. 811 Jefferson �"' Utilities N. 811 Jefferson /Plan Review/Fire Prevention N. 811 Jefferson n,; /t/ Vitti Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address 1 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. Signatur 1L-eAy(-- Date O)42,e,4 ild24 AcidAes5 ; n► 520 N/ANIE_�_ Agc IsS Ny . �/t�01 Sc;A L 1 - 2t `= Ise FIc, ;►e: bfs&/, r F/AJIsh�.O 4f�ti � (3tk St !MINT NNFINi5*ICn 659 csARAc. SZF �4dd,zes's n152U N/Al�'lER Lr_ GAL LG i 1, iock., 2 i\cici. ,PARce.t-, " 155 yy - `lir° S<ALE 1'•_ 2t` - 1=r FCiF5 4 l3R5F/017- FM.),5hr`D ^- i-3AStMCNT NNF/N;S!-12!) 655' C-ARAc 52F' 77. 4114 NEq Y7 3Z E Lc V, 2 EL EV f Seo N/A/VC- i_ Ss�BE.E k'.C` I31vcK Z , t3eRkcR Adel yq- 1&oL '--'-rcaoFL ?8 5- 8 asts4kA.'T Fiuisjr.i) 13NS<.M"C uaF,u1s1{r;D et,Yy A -Ce< 5:48