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1985, 12-18 Permit App: 00009194 Residence(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF TH-E 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 1 Owner's Name N/ "19444 - LAST 1,1 .1 tie FIRST MI Project Address (Street Name & Number) /a 7 1 .. cS`//1To Zip Applicant Address c i e — cSu r� ao,3 City PC oq.-,v State Zip 95aoa Phone ( ) Business Phone (t5"a9) c:1 -3',S --466a Contractor/Agent �/g//e City �Pc,e..• 6 Contact ^� 7Q.eP/A Address S' /o/ 4e ;-19-c�c,7 cPo3 State 11)/9 Zip Phone ( 9' SSS-- 6 G a Z_ License Number (Required) ,A/,4LC? c2/log Business Phone Architect/Engineer Address 9) 073s --6 c. City Contact Lender State Zip Phone Business Phone Address DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my agen to compile said application is true and correct. Signatur Date Approved�� Cond. Approval Hold Environmental Health Application W. 1101 College Room 200 sem— # �,7 ` oe 9 Deli* Y �, S ` .&g.-th:y7 II t—i--. 'I.....t,..____________.______ rf2"/A-2,1e, Planning/Zoning N. 721 Jefferson Engineers a / nL/ N.. 81111 Jefferson '4- 723— '4f / Utilities N. 811 Jefferson 1 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 agen to compile said application is true and correct. Signatur Date (13 r-. • iR�c_r old o fi-r v iZ �4t 4_f iv 1 / /pooG0-- ?RN � \tel nl?'© AVL - ^NUC 143,! CON L. lot- u iDt 1' 1 7000Le 6) CONTRACTOR: HIMALAYA HOMES, INC. ADDRESS: 12902 E. SINTO LEGAL: LOT 1, BLK 1, PROSSER ADDN. SCALE: 1" = 20' z A Q J11 r 1 ge a") / cy 4 1 cr 00i 4 /Jr4'r'cJ 2 Al_ r4por-4 S . 3 -o /o0o& TAN A-- 2 / /At for • • 43! Cory C. lo- u rDL t • • -2 14"; loo CONTRACTOR: HIMALAYA HOMES, INC. ADDRESS: 12902 E. SINTO LEGAL: LOT 1, BLK 1, PROSSER ADDN. SCALE: 1" ,DkJ"' L2, J 0 0 6/-0)