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1986, 06-17 Permit App: 00011638 Residence
(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) O r1P1VGV P1fIP10 P1fC r1/4.,r1 IJGrf1n I IVI GIN 1 1.1L %JOG P feet Number / 42. Owner's Nam LAST FIRST MI �t?ei i y bio c.._ ` // Zi Project Address (Street me & Number)i`--(g-C-- ©u-rN 35c&Mg-`tss4 4 Plv& (42o10 Applicant _).":2, P Address , / p.:,/- 'S , i,f 2rDc-E7r C-,-, City - State , Zip E�� Phone o Business Phone Contractor/Agent G/?eI1'k yr / /t/ C - Address City State Zip Phone ( Cot /-/Z 'v/( / 3 License Number (Required) (>S7€11 V.2 1 ✓ lai Business Phone ( ) Architect/ Engineer 007/87 Address City State Zip Phone ( ) Contact Business Phone ( ) rs Lend/624 Address _ G624s5 ,/[ /�t CI S �/0=rtr City State I Zip Phone ( a.i 5 / it./ Ce Res. / Comm. tP /Short Piet Number ter• /40,11 E_ / Parcel Number Lot Block ______ Plat Number rtinentFileNumbers Zone Comp, Plan Census Tract �of Dwelling Units ,gin -R r Number of Buildings I Lot Size (Sq. Ft./Acre) Depth i1-7 Frontage -7 1 Setback ;, / ..� lett Setback 20 Right Setback - /d Rear Setback R/ W Width . Cod itional Information BUILDING INFORMATION I Square Footage I 7 -li-*- l- / 510 /510 -ttF Number of Bedrooms 'r 'r % '46"....:, , r Date /7-e& Group�r l„ - 3 Type V to DEPARTMENTAL REVIEW 1 certify that 1 have examined this application and state that the information contained in it and submitted by me or my agent to ile said application is true and correct. • Signdm Date 6/7 r Approved Cond. Approval Hold Environmental Health Application # W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson I I /Engineers / 3�� N. 811 Jefferson -! i Utilities N. 811 Jefferson I Plan Review/Fire Prevention N. 811 Jefferson 6-(S-4cce, Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address 1 certify that 1 have examined this application and state that the information contained in it and submitted by me or my agent to ile said application is true and correct. • Signdm Date 6/7 r 4