1985, 09-13 Permit App: 00007446 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)
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Owner's Name LAST / FIRST MI
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Project Address (Street Name & Number) Zip
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Applicant
Address
City
State
Zip
Phone
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Business Phone
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Contractor/Agent
GOLDEN UersT Co,L»T Compx)
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City
Spol;p")e •
State
W A•
Zip
920,o8
Phone
(so?) y66-621/
Contact.License
.JOToy
Number (Required)
GOLDE cc 17,3-Q
Business Phone
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Architect/ Engineer
Address
City
State
Zip
Phone -
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Contact
Business Phone
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Lender
Address
City
State
Zip
Phone
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/Environmental Health
W 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number
Approved
' Cond.
Apii oval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
111
Other (SEPA/CrItIcal Material/etc.)
Fast Track/Speclal 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 is true, correct, legal, and binding.
Owner's Signature . Date 77-73 CRf—
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