1986, 04-21 Permit App: 00010615 Addition (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
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Project Number
Owner'sNaam: LAT FIRST MI
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Project Address(Street Name&Number) Zip
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Appliicca�ntl 0 / Address
City G J"State �(l (Zip �j Phone Q
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Business Phone
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Contractor/Agent Address
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City State Zip Phone
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Contact License Number i'rR,equired) Business Phone
Architect/Engineer 'Address
City State I Zip Phone
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Contact Business Phone
Lender Address
City State , ;p Phone — —
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DescribeWork r� - Res, Comm.
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t Is{ /Plat Name/Short Plat Number
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Assessor Parcel Number Lot Block Plat Number
44 C_
-Pertinent File Numbers Zone Comp.Plan Census Tract
i A6.3(.4.e>
Number of Dwelling Units Number`of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
r• SO'
f Setback Left Setback Right Setback Rear Setback R/W Width
Additional information Square Footage
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m Number of Bedrooms
Itd•• echnici D'atlJ Group_ Type
- 11
Show on Site Plan: Additional Information: ) o
Lot Dimensions Landscaping
Existing Structures Drainage Plan
Proposed Improvements Hydrants ______ __ __,__.___ _ _ _ ____:_-_
Structure Setbacks Topography
Easements Lighting
Septic System(s) Signage
Water Lines Shorelines
Sewer Lines Highwater Mark
Fences,Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
1,-T N O t L 4—51'31.AG ZO
S. So' c7 F LAD`Iz t_4
- 86' of L5
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Scale:
I Date: ----
„I Revisions: Attachments:
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DEPARTMENTAL REVIEW
A•proved Cond. Hold
Approval
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Environmental Health / e
W.1101 College Application M ?0 `S4h '
Room 0• "t
(� _ ccs QQP Za 0--- 0_4.,( 2� / 0 a 0 i 1 i
Of 0°0 ef -ct),( '
Planning/Zoning
❑ N.721 Jefferson
,
Engineers
❑ N.811 Jefferson
Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
fill
❑ 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 Date
Fr. CENTRAL PRE-IMIX, CONCRETE CO. ,
1► Spokane Plant Location _ —
- —+ --t-- Kent Plant Location
Broadway and Carnahan Fid. — 21000 77th Ave.So. t j
}- f-` Mailing Address P.O.Box 3 66-: °e F,`;F;E' _ Mailing_Address P.O.Box 510
Spokane,WA 99220/phone:(509)534-6221 Kent,WA 98032/phone:(206)872-8916 -,comer Insp
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