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1985, 09-30 Permit App: 00007766 SidingBUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND . (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name /`/1 (last) (first) (m) Capertment ly //�l,r/) I Ral. Comm ♦(/�/' Space Zip 2 Project Address (not Mailing Add'pr �'/) v Road Name e0— 0 /a" !)� � ��2/� 3 Gty/Cammuni ��u� State GJY� Suhdy�ion/Plat Name V.�ENs 2 ✓£>/2 4 Assessor I No. '5s'/2.-Cl 3 Lot I Block 3 f .• DEPARTMENT USE ONLY `7 5 Slc Code Zone Act. N Zone 45 Protect No. 771.0% 6 Dwell N - " No. of Buildings Sq Ft./Acre /0366 Depth - Frontage 7 Set Back -Front (L)S-1 (R)S-2 I Rear Gnus Tract Module No. Initials Y' CV (.971 16 Architect Firm Name Street Address Zip Gty State Phone ( 1 Contact Person Phone If different than above ( 1 Contra,ctp� Firm Name Y�IGv 4a - � ��'142C Street Address , A? ..�?Dl fi i Zip Gay State Phone 4a45-- 6 yet is -o9) 9;7-T-4 Yt CQg991a2 flew f/l.<.I/ �� I/frYl � Phone different thane License No. un �"i/l�W�G3�/�¶u&nnAddress 8 Owner/Ape,U�((Il diflerent Menet ve) 9 Zip City Slate Phone 12 Review Required Plan Check (Y/N) Other (Y/N) 1 SEPA Exempt (YIN) Date 15 Type Work ❑ 0 BldgElDH Firere 0 Demo 0 New 0 Add/Alter 0 Replace 0 Move 9" Other at //( ( 14 Describe Work r 512(44r 10 Applicant Name Street Address 11 Zip City State Phone ( 1 Lender Street Address Zip City State Phone ( 1 Contact Person Phone if different than above ( ) Additional Information io i/ ,Yi1 Lv74 f ", 0 2/5-35-. C C I 7-ee 1 l"O° l.S0 = 4, ( ,2,.570 le"s`'t