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1986, 10-06 Permit App: 00013479 Residence-5270‘— (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) j JnnvLv nnCn0 en -IC run VLrfsn 1 IVICry 1 HL ux bar 13111 4 .:. Owner'sN a LAST FIRST MI �AZS L S4* / 205 Project Address (Street Name & Number) Zip 8 322s W I -ft PP(C sPoraNs— INA. ie, 2-64 • Applicant Ce)N in tact© Address City State Zip Phone ( ) Business Phone ( ) Contractor/Agent R c&M C s7- Add ess Pd + gh,,c ivzeo 2 - City SPOK,aNe-- State w A. Zip 99 Z/Y Phone (S -o9) 9Z7-o27L Contact License Number (Required) gee/Her 00 ik / 7 g Business Phone 4co9) 92-7-2-r2I Architect/Engineer 116A/tfl NCs I IES1Crn/ Address t /U Seat/ 71l//SIor/ City S'PoxaNe_ 'State M.,A• Zip 9 92.08' Phone (co 9'1/6, 7-62-oc> Contact -30-P1--- kthl(s Business Phone ( ) Lender CaL)`s4diA SA -vi NGs Add ess N/WO >Noe.>rtaeia. Cityp 5Q6KAf✓L State 1/..)41/..)499-7N'P Zip 1�� Phone ( 5b91 ial 724,- 7726 T 0 &A �r.. tip,ra s k • rc.::..._,d_, -Cr Comm. (SJ ct n tf ...gne/4latgrbe(a ,...4"c 109. (thrvt6 '41-frr _v. )ht(nber W -k •, - wl Lot —7 Block Plat Number Flh•lumbers-: +T + Zone Comp. Plan Census Tract • pwast$gJnits *Nu 's Number of Buildings ( Lot Size (Sq. Ft./Acre) Depth 401 Frontage SS/ ,ro Left Setback �1 Right Setback 1. 1 01 Rear SetAbac/ / C.o tip R/W Wldtb l� I (7 .. li Ion 4EYm e PA 1'6-7 M , r) I'rtbte i' CT- 5,j ZBUILDINGINFORMATION y �'I Square Footage t z�s Li it,r.�^Y q1•+ Number of Bedrooms .. lc Date' D Grata Typgr3 Show on Site Plan: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Additional Information: Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark 1 Lrt Legal Description Sflana:»4ptjxxn01:4§; S t4-ki“t[tS4 °' Stl•1$ f o1(14 ytyS J 4ilp111 }Y -t 7 3 iA4flinA. 3: 51 :NYYia:nitd•h.:h e 1 v 4. Scale• Date: . Reyisions; Attachments:. t 44-14 4- 1>tt t>7t:if �yt 4t4Nx1Ai t1T144f t 4AY st%i>itStrPt;'sit:tt:tNSs?uhi 1 I � t t 4 -> I 4 L 1 ' } t J- , , _ , i 1 r .- f T y ,5 i. 1-1. i±= 1 1 ID 11-9 —'' , 7 . 1 1 , � +r. E ; - ; --- F-- I `II")P: t [ 1 1 N• t/ ' i t x , a') "� I 0 (1 I t -}{I 1.? ------ �[ _ nb .1 S F — 111-1., O NA ccs tc. --- •.3�-10, 'OS 1 11J1+ 1 i. � -I { � $11-t \ I 1 1 i 4:fr)I rt r { 11 (k . 1 1 I ( 1 i' _ DEPARTMENTAL REVIEW Approved Cond. Approval Hold Environmental Health W. 1101 College Room 200 Application # Planning/Zoning ❑ N. 721 Jefferson Engineers N.811 Jefferson Utilities V N. 811 Jefferson 474 /0046 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 Date