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1986, 03-27 Permit App: Shop Bldg (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 I Project Number Owner's Name LAST FIRST MI Project Address(Street Name&Number) / Zip Applicant - Address 'D9G� V ti' y U T` l fGy0� /0 X00/O � i fere City Stat Zip Phone / ,5190K• CO A-51_ q?2_12_ (5o ) 92g - O4/c7z Business Phone 'S©V ) ,5's —O ,'/ Contractor/Agent Address 136Ke1(—L111/4j0 dtk/C.TIZlACTMt.) E (Do t" .. \J.,..0,41\.,..),-.,1 City State Zip Phone Spo Kati WA. CiC1a! 7-a (Soo ) 55- a'N-to Contact License Number(Required) Business Phone Fla lat0Y. EcizCiL-1►eiD - 6s244jLC. ,- f`TiLc. (Seel ) S3S - 2'74L Architect/Engineer /� Address £W'CI& 0 A /t Sse,ClArEs C !`� a4.<.e.e•L/ City State Zip Phone oK4.tuE GC/,4 9`='.7e-, 7 (s-ccr ) y.y9- -7// Contact Business Phone /I,,qAEC S oo,WO/S ( Sij ) 'AP 7- =2-%/l Lender Address City State IZip Phone l ) Describe Work Res. Comm. 4 L( : i Sip bui ,a:),. V bdiv 5ion(Piat, t jet rier Assessor Parcel Number Lot Block Plat Number J 51?/—' 06. _ l St`f Pertinedt Numbers Zone Comp.Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage —` Front Setback Left Setback Right Setback Rear Setback R/W Width Additional Information Square Footage Z Nib 10 12-ttC0 --I fx u.z 0 B. J_ 5 D] Number of Bedrroms Building Technician Date ( Group ? DEPARTMENTAL REVIEW Approved pp Apprrovoval Hold Environmental Health Application# ❑ W.1101 College Room 200 Planning/Zoning ❑ N.721 Jefferson Engineers ❑ N.811 Jefferson Utilities I ❑ 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 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. SignatureX���� Date `7 ..-- '-1?—" r e-c -_ - /- 7- ----- 4---- A,/ 1 -- ______ __ ,•(70,`") 44E4_ / 1 1 II{ ir -- _____ -A- _ , 1 , 1 -..., ilf,- \14 ati_ <-----7 - 1 , . 1 • Si •V>'x G,o' 4L( I S A 0 f /I-Axil ...C-YakAc...6" i 1 i II 1, .____ isoo —1 i\'°°\• ' Ci•)°o1, s/ )....s•to<,,,...., v \Col > TA 1,1 e... _ ___ i 1 1 126‘Tfooni , a itk vo u_ I 1 • I I 1 10 J —______.i...._ i 1 --- -- 208 4614 s../ I --.• i j, y ----- Proper i,.. 2M16 } ; . I 1 )ott.7 > 5'4,99 SA.902.P S Loc-g- 4d r‘ 4 or. 41 r 7100 3 A 1 p • . . . . i . . ' _ ! i - i 1 . 1 ' 1, L I, 1