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1986, 08-27 Permit App: 00012841 Reroof(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) H - Project Nu beI2Arr�g .y' r„ -J' . Owner's Name LAST FIRST`:'�•zs: yMI ' /(eijT L/LL/C Project Address(Street Name Number) Zip /o(7.>2.2 4- 717f5S/0ma sPoi«tic'— t<14, 992© G Applicant y7 5-7 /'rmCSr Address cr City Spon/4/it State 6,20 , Zip 99 -0 C- Phone (5° %) pita — 4'9'V Business Phone Contractor/Agent Add ess City State Zip Phone ( ) Contact License Number (Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ' Contact Business Phone ( ) Lender Address City State I Zip Phone ,Wo' '. ' .3,•S_..).,1,^..-, W (C�! '''' Ei•V /L, "....` ..,� - 1y, ' x{'o es{;?,s Cdnircil .-Cdr -.D94,±thkr'F "_=. tfi iSubdylalonfP}atName/Start Plat Numtie: , w' b_. ...l fF a i:••••Y'•'=•"'S' tyi .i_Nu ,C....-: "ti r •Y•: yAStes3 &Pafeel NUmbef- yw".; Ss "'�. A'' ['+i N"+,{!'dot'. ::•,,t-ua.'•c:/F..+rk-.'+c'l}•":`^`t:..;Qe'," ff°y I S+*'r':: { iip nYT+y':$±t+"-"Y, '1! L V' ,t. YM'h: fM u.l.' • <'uf.,' .-d'�iw \f{a i-L,;�I.a.`..�,.'. 'b .::. 7 :':: 't':i� .. •I •". 4 4'+ 'Block _,�•.3^•:i'.'re:; 'A P"LlNY.f ."•,L':.vw, _:•.. +:r i::e Plat Plat Number'," (Pertinent File Num -`:. _.:e•..r:."--r--ns' ,2. 2-`Y•k, Eon :;7:' . .fie'`�:"''; :Y.'^'` 'iM1u .)R;ti. s:. E°'R...�.-.,: �T N;at'::'r'��ii4�%:sn,tz y:P::.11 �': i:. ;.. '{•'. tZone•,-. ...l . 'Cum "Plan's^-`'4�l"•^ P: Y `x' '��±G: n�' i7ii��»4`#eS •r. .Census Tract . _.. .. ..• tNumjIttt:E�pf Dwelling Unita'•4'•tl.- !j.<sK r,% rte' y \'S'J ,N,�i-�l:v.r Si. -S' z'�i'c.+.,�n:: x.d �`.-�t,i "'Number4ot uil ing _..t �.+. B d' s, 'i%'' tit:V- SL y,l P:i zt� -). 1/ '-" £ MMV.. 1 'lot Size (Sq. Ft /Acre) ^T�!'pl lad tib "(H(ii .':. ,,.c, . '.�< Depth,*pi 'F'h. ri,� � t �.^'.,k.4�u•<°i* Yr- �..: r.'eS!.a,.:. Frontage Frontback:+ ;.''.+L.i.4 Left Settle -6k -o, :G'ii'�ioY�);%x+: Right Setback._. i' '.+"Y.c i Rea,Satback,a.�+,w Ir ,_: R/W Width-. -. Y°sc;W 'AddltkrW Information -it, „y *3r.;-�.cr xa: .,-..;'t•,,..1-.7::. _ _c!i. =. '_ ..Y` Y..: -'.•� '': ..1. ye ;;''t::.;..,.i-'y...,t�"r�r,.,',.'.',y�r.• .,K.0-- 3Xme.+ 2 .+r., '•l^ . !>',?`:�.,r:�L'.-4 i-. ��F.fvi"i rda'j''r^S�`N: wiT+,` �'rn ' ': S� J" .� 0,4+ ev_ K' .4Vtgie , .O. 4V=i :Q' ;cc, 12 LL . U' f 'z,... 40. :J" • oa_ X�NF:� t'w+s 4' .Sq 9 �r._:r-:.-. •.. E?.:i rr i - , --" '"• ..- _ •• ,..• . i. „,may!'.. :. "...-7,-,, %'Y?{ Y.P:Xn"i ., y.'v,.• 4-tr?-J' :' 'F: 't �• _ -5LItYs`-,°• if-'.TM,rx.:A 4`','?: '"=-?,Z ii ^:5 "a':.':.� _ - _ _ ^s4':L-rt..'4 a-�-�.`••S'ti.:rr{e�.{;k _: �" 'f-:` 'S �.yt '.+; _ _, �.r.. ,,,.• yy r.t+rF.�,£.,.•'/>Yi35:r.1:.'H:;-,:i£:r'iys,� •'3i: '. .v oc' ... l.'..: (�,5r'r _,� .:?•.:i r'�'4 f _ S',<t`: +'� �'_ .Su, ..:.:. ... _. . _- �'h('".fj••1-,i �^rs'` :,""-:,i:�.,!"' t�.".},.'`^.,.: -. yr: �' 'z^�' •'�"a'i''i y'.- .! V y..''!; .,Z s�i _5 't.._ ,C::Z. +. i;. Vii. 1:..'•,s. . - '$.t... Sy:>, ;(`¢". L,�,,S5^��a`.. t'iry"u'•✓*.:.t:.:i•. r: ``>,..: s' i`t`A ;. 3�.C,., • v',p`%'i _ ''.i 5..": «iia)eV.:ia�r_w"�-.&?v;^,.S'r-:..,...=.'"'r•.AI2e��i i..-�.xP[xv'7-+k'..5ii +}; `*-'. ,.'xtt?'.' �..ys.W' , 'F 'ae.�_`_''� ":, ,i; man ••^ .a. ._ ...... �'x* y .r":""": .�;..�{',ti `r_ a'.I ^.:i.:/�'' iC.T•:`F.^�$i "i"'�.'y. r: •i: �r1'lr,,r�"�5Y'•�,�"i',',' Pc r_ 1.5p. .�`G. ,�',• }�'.'i: i._ kM." v]_•. 4. `J .. r..S ;t'....: xi HrSG K-- �• ''11�' ";,f�'v .'✓i:�` �v c / 'Yli'. '1,ti J'I� S<r • 1. , • ` " Yt t"'> '.t \ �"N Y{. ':PYv. i lit _ w-: '''Y :1" _4S a V ,y; -'Y' i M1 t ✓' i ��ppr .u1`wttk •y y.�Y._�. hS 4. `x ii:, 'E. - h. _ 1•' e:-, J.;.„. CZ c Number of Bedroom s, .. , `s- ;1.L..,iw+^. Y le Sad in0:Ted, anSy^'s;' .s ':.Date:"�,t-Y-, v;:c•'r "; ;:4.'_::_ ..-e^. ;.M1e,.y inti+: '?`: ,Groups_ - Type' DEPARTMENTAL REVIEW I certify that I 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 CpApproval Hold Environmental Health Application # W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson I Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address I certify that I 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