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1986, 06-03 Permit App: 00011376 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) w-IHUtU Hr1tRJ Hrit F1,J11 UtYHti I MtiN I ML UJt ofecE'Number 111 ( / [ - 1 Owner's Name LAST FIRST MI II 4.7-iVeze Project Address (Street Name & Number)Zip S. 3 s 12- /fh3 s: -r v.. Applicant Address City State Zip Phone ( ) Business Phone ( ) Contractor/Agent s e 'S Address 'moo. %3x iyie� . City State Zip Phone C/ Conte a 2,e.v®/c / Licerz.s.a Number (Required) A/O/C /7/-2/ 2-/. DZ-. Business Phone (____ f-2'7€, Architect /Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender /..4-....-34-c.04, ...(7,-./ — /�. Addr l veks/e,' cr. A 7 exr 6Y/a)AI A G J ../.�.-,rte- Sta eZip G.�,�..t - I �1zC Phone (47/-_;5-1 77 7 / te�/ t "C� �/ 6 F> r cam/-�,6� � Res. Comm. /Plat /Short PlatNumber 01 C4,141. -C-- (2-0 pc -Dort -7 01 --- parcel Number LotBlock / Plat Number Pertinent File Numbers i Zone I r�� Comp. Plan Census Tract Number of Dwelling Units Number of Buildings 1 Lot Size (Sq. Ft. /Acre) Depth i0'7` Frontage 7-) Setback Left Setback / r© Right Setback g ' Rear Setback s_ R/W Width Additional Information $ 1 Ill V7 _.... PI ArivIs CI ' Square Footage f -F = .1 93 ;,'BUILDING INFORMATION Oe. - Co E5s Coe5C'wrL . • l' ` d ' � ::^ Nurtiber of Bedrooms- - - '' - - fJate ) a rsroup • Type• DEPARTMENTAL REVIEW I certify that 1 have examined this application and state that the information contained in it and submitted by me or my agent to compile said application is true and correct. Signature Date Approved Cond. Approval Hold Environmental Health Application # W. 1101 College Room 200 SEw c rz Sq s -c5 s✓\- Planning/Zoning N. 721 Jefferson ngineers NN GP el'E�� -1` 9,;./N. 811 Jefferson Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address I certify that 1 have examined this application and state that the information contained in it and submitted by me or my agent to compile said application is true and correct. Signature Date I 1 1 1 t I 1 1 ! 1 I 1 t L.. ilk t 1 , ___ t • , 1_ _ i. i _ ' - t , , -1-- + , t I I 4 - V + t A,„ ___„4.: itt,s I ,_ : -, : , ______,____,, . .• „, ,..--- ............-,...........................---,—_, ,___ ; i • - . ,. --f-', /1-' tt ,!-7 .. t . - : , ,•,,. I. . f. ,.... -c -'t r%1 : , T+e # ' ' ""-..‘'","•-•"----' 'I X ''' '-'0 L.,....., ..--- . ,...--- .--.1.* > -4 . . , ,,,, , .. , -.r ; t ,•.: ; .,... , , , ..,,,, . il. t1 1 t ' 4.,- i / F , ._. t I • t- Z i / -,--- . . / 't13.C4 • -t 77'