1986, 07-15 Permit App: 00012118 Duplex(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
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Owner's Name
600 ///i-)10
LAST FIRST MI
Project Address (Street Name & Number)
/ai a 7
Zip
Applicant
Z1h'/t/, V d eco
Address
City
oso/&4
State
Zip
Phone
Business Phone
Contractor/Agent
Oo /[471,0 a" ee,
Address
City
State
Zip
Phone
Contact
Architect/Engineer
License Number (Required)
L ift oe i4/0 7)
Business Phone
(
Address
) qa f�59�
City
State
Zip
Phone
Contact
Business Phone
(
Lender
Add ess
City
State
Zip
Phone
Describe Work
Subdivision/Plat Name/Short Plat Num
/�/e$:5/ '] 7\
Assessor Parcel Number
Q 9.1/3 —4,2 .6/3j ..26-)/Z
Pertinent File Numbers
Zone
Comp. Plan;
Census Tract
Number of Dwelling Units
Front Setbacci,
Additional Information
Number of Buildings
I Left Setback
0
Right Setback
(0
Rear Setbadt
R/W Width
56
Building Technician
0
a
2
0
z
z
0
.J
3
03 Nurnberof-Bedrooms
Group
E -
Type
DEPARTMENTAL REVIEW
1 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 tion is LI Et and correct.
Signature
Date
7A -A
Approved Cprov
Approval
Hold
Q/�
Environmental Health Application f1' ��
W. 1101 College
Room 200
ry\„....___
Planning/Zoning
N. 721 Jefferson
Engineers
-
3
ry
N..811 811 Jefferson �L
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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
1 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 tion is LI Et and correct.
Signature
Date
7A -A
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