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