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1986, 02-18 Permit App: 00009849 Residence(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET 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 Owner's Name LAST KVR3 FIRST MI L. Project Address (Street Name & Number) .`3310 Zip Address IQ Di( 6LIQWE Contractor/Agent City GRry ACK S State \A)0 Contact Architect /Engineer Phone (509) Business Phone ) UT) (e5 L, 6 Add ess E Kk oELv)t License Number (Required) City State Phone ( 569 ) `iZ (a 85-7 8 Business Phone Address Contact Lender City State Zip Phone Business Phone Address Phone DEPARTMENTAL REVIEW 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 applicati n itrue and correct. Signature Date Z_ /18) ©L 8 �o Approved Cond.Hold Approval Environmental Health Application # ri -ea? .-27 W. 1101 College Room 200 t")..../014:.;/..,*-j,,t4-7,.....W6j -rr,,) ;��� Planning/Zoning - �vt; a,L( ii_ec,,.x V C iit 6 6-7 b.-`�s../7.1 N. 721 Jefferson i r !I/ '7C) -/ fit' l nr:7$'' ((- Z-- z*JT S .,i. -",,,,,b z/ -o ,f)e'"C- Engineers PAM' �� Jefferson //Q r 4 N. 811 / Utilities N. 811 Jefferson 001 77&,/LE P.ZL/A1a'stX; RE L7 Yeil/14frie Plan Review/Fire Prevention N. 811 Jefferson 2-1 -' /e66 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 applicati n itrue and correct. Signature Date Z_ /18) ©L 8 �o *2 •