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1986, 07-14 Permit App: 00012115 Duplex(THIS IS NOTA PERMIT) ' BUILDING PERMIT APPLICATION WORKSHEET I °2 - 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) anrwcv r,ncna me rUn vcrMn m wicn ince vx . p,7, —' P`o)ect Number • _ 1atI;t: k Owner's Name LAST FIRST MI WO/r/A- )d Co. Project Address (Street Name & Number) - Y // /.lc F '. / o Po 9. ZIP Spo ka4,�c 1406 Applicant Wo! / /AN l Co• I nderess`/7/7 /-/ Ale S City . poi a,A e, Slate (W • Zip (?9,2_400 Phone ( ) Fa 09 -L,75-9‘72- Business Phone ( 1 Contractor/Agent WO 7 /1-)-,dd Co Add ass City State Zip Phone ( 1 ContactI (('' Ui Alee �1 ei Pp License Number (Requited) 1.001.t 4— /yo DM Business Phone (• ) 902if,)•s9,2, Architect/Engineer Addra,ss City State Zip Phone Contact Business Phone Lender Address City State I Zip Phone Describe !Nor, •;:rel.,: -d"i r_F�P.'yi:,x .r --.>� .w, -*.. - Y"': .';.:{:t'ir:+t:'I ->_"i'd!' •�.iaR:i.. ss.'2 -'r t.,. � ".?:""6.7-' .',k�'a z. - .. 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NY=:3T "rFa•:� i. ti ^ - r",. .�.. /.3' .a. u w•� •: K'.1 E. `:!:> u ;v}C'?",.v:pa a r£�n . ,Zf ;ral D, 'COI F�ryryee `tom^' "r'• - �y, ..'-.a i,:: :;: k.n:.. •a��r ����, a?:Ss'3H :':..; ...,'.�, yti.,x`K y, . liSY C x '-s -:'r�'�a _ p..., y.. y ^%>- i�.4,r`;"kr r• -',`': r"„�':"k _>K%x`=' r w { .•!.(dayr^Y,.;: :a !a:g: s �t)t.�•i ..c,�,e xa li:m "Y: tf n - F z .t . :� ",.'•„ 1, w^'•^ � { h K w .}�r`. r .'''�' ,w'r:"•r.^-:. -•„ , uY . <:: r �gW,, trcY frft} ti 'scT.''.: is�.r^„ '�Y. r.'/.-:. m��'Si."'"�F' yuo-- - .. Iff...se• �Y'i..-i`'�K �v_ Numter of Bedrooms.., ;w' 1 ::yy C.'..�J. J'a wiy..VMa,' t}Vw ae-__b{•' Wii Tei /S. i>l� "�w:4 'T i n+i-vti i�.a }'G •.tui iBuildl Tedhnleftuf -F% !10 '�{7xj/�j(]'/-.jl}/y/^y/%q'�i; -- 4,24 4�N >n Y� Date •' u d'- i C" a.i= re. Y r.••... s r.ra�:{,:'+'*,.':+,:s-:1`W=• t,i 4: ri t a Y9 @ . . , . , l .1,-/r siSc^ia':^ r...i-5�.:'-c i1'-.1•.: $kr^J:.^... ",s.3'i>1Ss^,&7.7.•-•+.I,h r -^.•mow ;GrouPci4`:. _.TYPa•`(4`'.-»' td�[pjl _%, ..',• Y`Y',a'... � ltdc41.' .• ),'4.: }r•. Environmental Health ❑ W. 1101 College Room 200 DEPARTMENTAL REVIEW Application # Cond. Approval Ap rove II , Hold Planning/Zoning ❑ N. 721 Jefferson Engineers O N. 811 Jefferson Utilities O 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 i9 true and correct. ea2toe Ce Signature }_ J f2.‘n-n ? 2��4) Date 4/46 0 de? 5/C /'i/C orlez-exx 90 Sy y eit 3F , 3E' 3 5' co OEeIC ELS r—o .05 I -- 35/ ry S codlc . all JE 'rI nilrlrePf, /000 DCe,c ': 4 St -boa /0 T. M4A J Corte PR WC 5L.oPG 3a' Co,VC_ ELOC14 I� ,Lb?S 7,4 8 /n'ss/nti QiDgC E, /0 80/ 403 Akei4 / QC,