1986, 01-24 Permit App: 00009488 Relocate Residence4
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET S / 3 Z- ��
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)
annvcv nncnu nnc rvn wcrnn I no cn I /A P.. Uoc
Project Number %pfek3
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Owner's Name n�, LAST FIRST MI'
-RiAJ4LOS Enf2g c
Project Address (Street Nerne A Number) Zip
pfreki - E 1141a Ave- l/2/‘
ApplicantSAMA
dress
X52 / S/io1 L/N& Ce
City
LA K&
State
State WA
Zip 4g6IC/
Phone (Seyl 255-(0287
Business Phone
1 )
Contractor/Agent
Address
City
Stale
Zip
Phone
1 )
Contact
License Number (Required)
Business Phone
( 1
Architect/Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
( 1
Describe Work
(tLoCArMO PES /Daru)/54sE/1En/r
Res.
Comm.
Subdivision/ Plat Name/Short Plat Nun'i el
• __
t_z _•----'—' - amt_ - '-
_ -r• _
Assessor
Assessor Parcel Number
454-3 —0/2/x..
Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
/
Number of Buildings _
-1
Lot Size (Sq. Ft./Awe) -
Depth
Frontage
Front Setback
Left Setback
Right Setback
Roar Setback
R/W Width
Additional Information
l-kusc- LOCA TE o 4-r 1/702 e- ISA, nu
BUILDING INFORMATION
Square Footage
/CL^+r) 7 = K�
SIP IHS• = FD.oe
. n e -- ` 8 I °°---
°Sc
3 c-
Number of Bedrooms
Building Technician
C
Date
/-2I-8/n
Group
R-3
Type
vNJ
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 compapplication Is true and correct.
Signature
Date
Approved
Cond.
Approval
Hold
/
Environmental Health Application #
^
rL —%Ws
W. 1101 College
Room 200
.Planning/Zoning 11//'�11 rr
N. 721 Jefferson `�L /Q -86 t�r�
-114
Engineersy��
/ FA/At-O L�
N. 811 Jefferson
tigl-
C
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 compapplication Is true and correct.
Signature
Date
-
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