1985, 12-13 Permit App: 00009151 SidingR
tau/KALI
•BUILDING 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 Nemo Bast) (first) (m) Department �¢ Only
L,,
Bksst r1,9I YCA in eA s 3l . Comm
I
2 Project Address (not Mailing Address) of Road Name Space Zip
E . 12 oq m o -i w -ax_ q q 21 (0
3 City/Community
5
0-o I.4,6 n
Stale
l,C.)A
SubdAion/Plat Name
C JC.v et,f s 72 , F/ 2
4 Assessor Parcol No
1551/2- x.0061
-
j.
Lot
�1
Block/
54
r
. * : DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Acta
Zone)
4-s
Project No.
1 i51
6 Daren II
No. of Buildings
Sq. Ft./Acre
/D O
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2 (Rear
(Ensue Tract
Module No
Initials
16 Architect Firm Name Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
( )
Contractor Firm Name
I✓1cUcu,1 61,v -I -hers Contractors, tyic .
Street Address
N 13 1o6 A- Jon n . Road._
Zip
agZtL
City
SpoKa-in e-
I State
I WA
Phone
(g09.) qzg-4-/o8l0
Contact Person
F-- urrut McNay
License No.
mt. Vf4 Y13C?)4Com6
Phone if different than above
( 5E1_ me.
8 Owner/Agent (If different than #1 above)
Business Address
9 Zip
City
State
Phone -
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N) ISEPA Exempt (V/N)
Date
15 Type Work 0 Bldg
❑ Fire
0 MH
0 Demo
0 New
0 Add/Alter
O Replace
0 Move
W r
1 \Pb�l t Ir
14 Describe Wor.5-& 516(-64-4 50 r fi l £ F0 Su o-__
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
1 )
Contact Person
Phone if different than above
Additional Information
Pcta-h'cy - 3 5oz I DD
Pt,rm(.+ Ra - S,V3- + 1.50 - #toq. S