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1986, 07-14 Permit App: 00012113 Duplex
(THIS IS NOTA PERMIT) r .% 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) SR I . projectNumber': t.12_1(,(.3:- ;time Owner's Name LAST FIRST MI WO/i//42,vC/ Ca^ Project Address (Street Name & Number)�- Zip . f. /0/0/ VOS //ORA 4 -de} o%aAe, 9.,?0 Applicant Wi /i/,9 -,oat go, Address s,7/7Lues CityState b e2 Wa. Zip c719ao6 Phone ( ) .9a/ -as9a-' /194/(6:1/ Business Phone Contractor/Agent � (/' �]�,r ��5i //'J /, L//—/,7NO 6, Add ess City State Zip Phone ( ) Contact /// dee tile/ License Number (Required) 14101, r4- t / O 3127 � Business Phone ( I 937-as-9ai Architect/Engineer io /i3 SG Address City State Zip Phone ( ) Contact Business Phone ( I Lender Address City State I Zip Phone I ) IDescrlbe,Work�[>fej,...L.:rn-..=/'ts-•d-t•.{+.Xti•'',f_.',�..t4:, a2`*.^'/\.rt:�t,_j.-i� jry {d%CJr-.4tW/'1L:_Ii ,/W<':..: ..N4 -„�Rr'-K's•,.� Comm (Comm T, an. -++1rt 'Subdivision/Plat Nave/Short'Plai Nr • :• ti;;::Jtl; ,E4., �;,;tw atrbetn isEA+! ,Z. j bfF ' ^ '..t ;..v._//+(,=CL \i�: tA53essOr,Parcel Numtier r F`"3+: va .. --- -, ,cc. fit=�fi+-:- ? di ^M1 ;Lot -. _ <[ - ..:� - ' 1-0�¢ Block."'-- ` s J . -.• . _ - j. 'Plat Number ;<;' •_ . - _...._ 2- c .: C,fyy�., ,`:r.._� 'D 9 Zoo.:7� °•dot : 3= bn: 'Pertinent FIlaNumbiis'!. , iiWi�.1«YZx�WAyn. :Zone,: Co-pPao: .....- r ' l{ .... .. .. ..._ :Censu s Tiact'. .,*S •.. .... .. i.Notnfierof D`welhn UnItstx: �: •);fV�^Number, :IV” dl•YteLor •-g ;.At'fa .,•C iy:'rh' -,:.. 4�- : - �'I -- _, of Buildings ,; _ W''.''-.-...:.f'�'T`., :.,"-` :, r : ::.,,' .. - Lot Size (Sq Ft /Acre) Depth.. i ., b ;Ip. ta, 13'4' Frontage / ... 'Front Setback;?3?`y- ?'j gay LeR 5etbacr'i:z„"i,'1 .e. ,RI ht Setback�.+x•�:q.,L ,R�rSetbaixk_,. !. R/W Widih=�,'�%.,.q IAddilionarl i orTation'zc' q:Y w> �'.1,}f`',4; : nef t • `.t • . is,,` . i<; l' :.,.” .>w,7:r...", 4t''.s.'-.-e:x�r.:-.. ".5 • o.: .c -rl. '',3�.�.+: ,V`Y £i'- 'i- M1y .. .\-,\T'41.... i.,) iC''••.:re ^T�Ytf+: ?Mia'�^Y.,'•'�a' •'✓+'i :9. �'i: ,:,.Ai -•:1+:•s .. Ts_.' �' .�. 'Square Footage-sr+e *-c ,.i: _ .mss.. ty9',• 1f C.":..._ -:. . .tr.u.•;.LL'e: ."•^Yi. tr';<.=til.',.pi'C'71'.7•7'>fy'y�;'4i� L?t.r:'. 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'", ••moi' _~ If••b. � ., - ;�^�� A. ,uY' .F. 3a•.s Nuber v. .uOi. , 1,.. 4 ^�,.F •L . `tyyt r i',u,.,,. „y„ .!,f:, i}.. �i� ` ..\ of - '°' ,�'>(• 4 .4=-^ �T ,�,���L•'SiA'' "'PC ".,• }, j +S!hn'i' •,yy1(��'.-'n'le'r3 L x ice'" +<. +'t<-JS^'2 Rh {G' 'V:.'d:K..:'r..Ft' ?BillIdingTeehnk»art �;.;� a F �� a s ..:�-A�' t t ..g"''�'a ate ".Y' - .+„ /n5_f//X4.' 4 '', Orb is tom„, a-3_ ":s•. ,'."'^._" K-.-„ ` '•5+^ w{�'{i:.d e, i ,i 'ra "ti [y: p!t:-aj+ Ys„ •e' ` .: •, i3-%A:'�a si t =n +G,::a:-.:m.=:. sL'"` 'u,. ]�i`rk, .... ad cu% ;', }, ms's D.,.••b'!.Y^i? oppyp ,; •^: `" ,1. ?a:.ar '.a 5 ";;S, ,:c T �i<, ,p YPe Fs, µ i'' "'L, -„s .Y �t Environmental Health 0 W. 1101 College Room 200 DEPARTMENTAL REVIEW Application ft d 4-e 790 1 ed pproval Hold Planning/Zoning ❑ N. 721 Jefferson Engineers 0 N. 811 Jefferson 74:51 Utilities 0 N. 811 Jefferson L Plan Review/ Fire Prevention ❑ N. 811 Jefferson 0 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 rue and correct. Signature ±� Date .7 G dg sic /y/5 o/JPLC-X e/o i 3S' as, 3 5' 35' r E 'y v F-i-�X 1/, 3S' /04,0 4 a L.. -4-044 DEC I/ 4 f CGEK74 o 0 T ) • 3/ I 1 $ cork . aRiJc I/ I I / oHeirea 51.4, oil /0 70 Ma$ cone, d sx'0 \\ a4, X— x` tj Corte. DRivE J. /vin% etock 1/ /errs 7'' 8 rn/Ss,o;;l PIK E. /080/ 403 Alae/4 11\16 ct� 3a' 1- .2)10 i/10 ._._�.. _ ..y..,-. C