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1984, 08-03 Permit App: 00001581 Pool i t. ! 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 (last) (first)�� l�(m) I DepartmentOnly Silt r� eRas. Comm 2 Project Address(not Mailing Address)or Road Name Space Zip seen 33/7 kAN&ARTER 79 96 3 City/Community State Subdivision/Plat Name 4 Assessor Parcel No. Lot Block —3-354-Z— .35,rZ —)4 /1 4 G� * * * DEPARTMENTDUSE ONLY * * * 5 Sic Code Zone Act.# L_� Zone 01 (12_ Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Dipth Frontage ?,,t./4 l 1 1tgf R4= * 7 SFr,,,, , I(71 t (R)S-2t Rear Census Tract I Module No. In* el CC JJt I4 © � * 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name Street Address �'TPL /A L "W.s, -ice• .37.6*-D � ''re) Zip ?.A©7 City S f9kf 14/E I t!State 4 Phon( r ) q -6-671 / Contact Person License No. (f]/ Phone If different than above /Fin 0445# 4PIA3-0A m R/— 7 ( ) 8 Owner/Agent(if different than#1 above) Business Address ..29ME- 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(YIN) SEPA Exempt(Y/N) Date 15 Type Work ❑ Bldg ❑ MH V: New ❑ Replace ❑ Other I-+ /t� ❑l FireFi+ 0 Demo /�� ��( /❑�Addddd/AAlltter frj9❑ Move , / 14 Describe Work SW/ _I' L/A4Sert°4 — INSi/Ti-,4 (l i x (/ 5) 2,10 Applicant Name M Street Address 11 Zip City State ' Phone ( ) * Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information I u iA% -01.s:CNC.. � N RY S`M t Tf %' satiatt N.5150 FREYA 6S.. 33?7 VAN f -ls4g ThiP aAQKRNE,WA 9Z07 SPvKt/t lAir 4,89-5674 89-567 7,14 -ge6�. cosy '6.6-9S7-42°- vit// 4R'r37Perr #‘' 645 4 164, (11 c .M- 174- --- ,• -7 SollAi nixes; POOL PSP ��N�