1985, 08-28 Permit App: 00007140 Siding 1---tV BUILDING PERMIT APPLICATION WORKSHEET
' PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (I. t) (firy) (m) Departmen Only
fa . k(1, 1 Res. Comm
2 Project Address(not Mailing Addr , or Road me 000 ((( Space Zip
: Ail0 1` 919437
3 CltylCo unity State �SubdivisionlPlat Name
C/, VEr'4
4 r Parcel Lot Block
'a5!/ � �� * * * DEPARTMENT USE ONLY * * *
5 Sic Code '/Zone Act.M Zone Project No.
_ 7/�b
6 Dwell 0 No.of Buildings Sq.Ft./Acre e Depth Frontage
leer
7 Set Back-Front I(L)S-1 (R)S-2 I Rear Census Tract Module No. Initials
t
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Film Name ( Street Address /,
r1/16-PliP ` t 1"1---' eet' 14-7,e-/A/R-e_
Stat zed 7) - ,„3/V
Phone
Corr Person License No. Phone if different than above
8 Owner/Agent(if fferent than f11 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) [SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg 0 MH ❑ New 0 Replace W" Other /y
❑ Fire ElDemo ❑ Add/Alter ❑ Move / C'
14 Describe Work
/Zi"/ -AL r
10 Applicant Name G Street Address
11 Zip City State r Phone
( )
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
Vaii./.41--&01. 1 -' i / ot°C.)
/71'9Ae.74;41 rye, . 31-/t 6 6 f/s , a ' . 5.