1986, 08-20 Permit: 00012737 Addition °0m111m01m01iw. °~
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SIGNATUREOF APPLICATION
O�NERORAGENT �L�� � ~ ������ DATEgt2� � �
JOB ADDRESS PROJECT#
2520 SEQ. #.
S TIMBERLANE DR 0014125 .'8/20/86 00012737
OWNER:
RICK P BUILDING $72 . 00
1.;.J;i4 S TIMBERLANE DR Building Code Fee $1 . 50 .
�.�,. s, �
RADALE WA 99037
`A/ RICK P
"°°=^="='
:SSA/ RICK P
ADDRESS:
S TIMBERLANE DR
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ADALE WA 99037
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924-8» `
�.,,. � ZIP:
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55434. 0110 099900
LOT& BLOCK '=^^
00065600 007 004
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TIMBERLANE ADD
=" S-1 S-2 ^^^ MOO
SFR F
01 RESIDENCE ADDITION( 10X18)
USE OF PERMIT: FEES: PAID
$73 , 50
=
S T» �' mur DR | /
252.o
STRUCTURAL
Building Code Fee TOTAL FEE $1 . 50
` BUILDING TOTAL FEE $72 O0� .
Valuation ; Curr 4320
Permit Fee 72 . 00
# of Floors 01 # of Bedrooms 000 # of Rooms 000
/PRIMARY STRUCTURE ;
. Desc ; DWELLING Group ; R-3 Type � VN
Sq—Ft 180 Occoaocy Load Ka�e 24 . 00
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SECONDARY STRUCTURES ;
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DEPARTMENTAL REVIEW
Cond.
/ Approved Approval Hold
/II1 Environmental Health F2r� Application#
Room 200 1 -k
W. 1101 College —�–pwTMIU p� ��
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson I
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.
Signature 71?-" /� Date
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