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1986, 02-18 Permit App: 00009725 Residence • (THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET I/`5 - 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 Ins Owner's Name LAST FIRST MI 23/1C!-,c ECSC 7�,<• &----_-C- / V C Project Address(Street Name&Number) Zip Ki - 1301 s Ki ewoii(i CTT Applicant Address 0//2e /c-i.e r7 /44:)/f&—S— / AJC__ . --oX / IFZ 9' City State ZiPhone soo,�,�ti� (.-1/.4zp 992.7 1/ (sol) q22 - 7Z7o . Business Phone ( ) �yv-dy c� ' Contractor/Agent Address City State Zip Phone ( ) Contact License Number(Required) Business Phone /f Ha /76NA 01 ( ) Architect/Engineer eg/C�/ / ` Address City State c r �OZip Phone ( ) Contact Business Phone ( ) Lender Address City State I Zip Phone ( ) Describe Work Res. Comm. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number (.____M Lot Block Plat Number 1(0 5 i 7 - A ' .‘ r6)14.1et) 4 1 Pertinent File Numbers Zone Comp.Plan Census Tract C..•- Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage I ISI SS ' Front Setbac Left Setback.04 Right Setback 1 Rear Setback RAN Width Additional Information Square Footage ±-or r 4- c 1 2 0( '%t3iN c'4.) tPOzrt c.... ,/!�'l 2 -= Mr I //t1 A-L. Pc ri rFes%) = oz a -7.56- -- u 3 I g cc 13. ' ----OAR III z 1, J_ m Number of Bedrooms Building Technician Date Group Type I -1u m - z---t 1--56 R _3 vtom, DEPARTMENTAL REVIEW Approved Cond. Hold Approval Environmental Health Application# if‘ '6 W. 1101 College Room 200 eyfrpty—Vitti 14/ Planning/Zoning N.721 Jefferson Engineers ; i r i, 0--_�/ 41 8t/ A. N.811 Jefferso ✓�l��t ice- L -G - i,1/%'��i� 4 .41 Ifwg • Utilities 0 N.811 Jefferson Plan Review/Fire Prevention ❑ N.811 Jefferson / v' 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 appli -tion is true and correct. , , � = . i Signature i r Date `\J� ;1 - , s. . . - . e i.- 1, • 1 T .,:"1:.• "N% D i ,< . / \\,,, 0,_• -• , " / "t• . .• .•• • 0 /////f..- N•s.._ • t 4 4, .///// 1 H ......N\ •••T' 'e.i. tr, / ///) " 1,/ i i 1.< g • . i '-' ,.., ---- i 4,47-ait N • F I Az,PT ti A-C IV t ,, ., .,, , t_- 1,1 0 5 LOP4% • •.."!,,-,•."-} / / U -, PlioN"- A .,- „ / -rt. ,f 4'4"-• ' MI ././i/-' 4- critle N. ,• _ . 1-4,7-ib 4 / IIII / / '/ 0.i_e ally 41.••••••••• NI 0 Al A) 5 1121k A. a i 0.. ,.... ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Oft OP I S°. C,• V • a. , ..... J. cp . ... . i r .....,. . L... ,4,.., 1.....i . . ••••••••••••••■••••••11. 1.• ,.. • c,.. .. ...z, ,. . 4...cs* - i 734.0c./ / • — - - - - - 70 g/AI 5,0 Li /-54.D.h),77 0 A-) —- --- '' _ 5,e) /e.47/V cf.;-. - • — ........__v. .......,.. .„ . _ . , . . „. . . ; ., ' f i . _ V. .... -- • • • • . t.... . ' _________,L4 --- .-›. .::::?. 4--;-'--- ;4.dif> .....;''''. • • . 7.' '. • �J -`� ` / If i . �.. �� • . . SD . . . . •. -. • �„ . i1, • i • ' . .. ,, •1... • • . , . "..--,- -..-"'l . ,2`,,„: 2' ..\.:`,.\''.\\„„\\ \ ' ...\.•• „• .. • .. ' . •• • \\,\ \ ' • . .n......6 0 . . . ,,i,),(„0-0-1,t4. . .4A q .." _ iiffiti„.., r. . • . . / ' A (0)0444,4004. .....11 . • Vr-\ : .' . . • SD�3� , A5r/tof -3o3y • • 0A AS F 9 • .-- .7 , , • i si.,,,,� . I OZ. / . i / /z);.--. L .,. ii Q� f ii, e 1.°I.* efifr:41/714 14 rfr er I f a sh. :- .../...."7"X/3: . . .� 1 1 :-\\ ----------- 5r,,,,t . _ _ . �..r....__