1985, 11-18 Permit App: 00008786 Residence (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
t 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 a LAST FIRST MI
V /ov _3 V w lie r /C e,LI f'9..2-
61 C
Project Address(Street Name&Number) Zip
1 3 o / ,J 5A-1, evorth L.
71,
Applicant Address
N /
eel lA/ ire)b /rvSb/-ti 1/.A2 / 4 /360 v
City State Zip Phone
O/f29 , ‹. Gci cc-- 9 9 2.-0 (5-61' ) 9 2 L - 2 6 1 3
Business Phone
( ) 5/,.,,..e
Contractor/Agent Address
City State Zip Phone
Contact License Number(Required) Business Phone
( )
Architect/Engineer Address -
pro Awq 71 AS, y it frz--c. 4/ ?4 v I Akii s/ z,ti
City State Zip Phone
,5-"c.)'f i9•z< t.0 C.:<--- 9 7 a ca P ( )
contact Business Phone
( )
Lender Address
`
City State Zip Phone
( )
Describe Work }''� +� Res. Comm. j
..3 f;i C)E t,./C6.3--- t/'_..`A +�c:� l
Subdivision/Plat Name/ShortNaPlat Number
1e,rihl 5Cf,t AO7.T 'CAi
Assessor Parcel Number / 2/� Lot Block Plat Number
Pertinent File Numbers Zone(' Comp.Plan Census Tract
FR
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
1 i /5C 85 1�
Front Setback Left Setback Right Setback Rear Setback R/W Width
Additional Information Square Footage
HF /2_72..95'
z F
O
Fi f EC k= /676 if
o (,,-A- -- 5120
z
CD u 3728
Z
0
J_
5
m Number of Bedrooms
Building Technician Date Group Type
Com) i t—r ._5 e- vN
.
DEPARTMENTAL REVIEW
Cond.
y�Al�pprovedApproval Hold
Environmental Health Application# -...... .-*...4._____ /'%c/��7
'//
W. 1101 College //172-1313
Room
�
Room 200 /
Planning/Zoning
❑ N.721 Jefferson
// ` 8.
i?,_( Engineers //
N.811 Jefferson F�� - / �1'I
Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention I .,---,81-65
❑ N.811 Jefferson ((-l/ (a
Other(SEPA/Critical Material/etc.)
0
❑ 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.
Signature e,.„,.4 6C2 /e.14-'1"1---V--€4-7--1�, Date /7 /D - G ✓ --
r/ /
,� _ _. �4 —_ ._ f�,• _, .--.E. 1_ __( _. __ _ .�, 4
I
. .. 1,r — _ 1. __ _ —
_.b
t
5 ,
t' ...._. _ ..,.. _.. a. t— a —_ -- r
t
e
i i r f f j A I i [ r f
,
f f
.
I ;
�`
it
x
1
I ? 1r
i , II . ----1---- . , ; .
, ,. , I ; �� ; ;; . 1 . ;
: _;.. 4 i .
4 4. _...,
, , . . , ; ,. , 4 !
-- _ — „
E
d_
f I -�
f it i 1
I ��
- -
lb ,
i
i 1 ' , '4I
� t
i
, t .f. .
i
i
— �- I r — s
H,
,
I 1 i
,
i
i . I f I 1 1_,:, 1 '
...—.71 , if , T tti_it 1
i_ - �__ _ i
I.
f
f rf
.
1 . ,; 0,-t, , -t-i•- t 1.- .
W / ,�
._ ..__ , ,
A/ ...... , A/ / / i - . i . SA / -y---