1985, 06-11 Permit App: 00005868 Siding ./77(--2 di)un
�- -- LDING 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 (ast) (first) Nrt (m) Department Only
Res. Comm
r (not MailingAdd'gees/
liar R d Name �� Space Zip
2 Project Address ) � ,
A , lya ��.�rnt ' - '7'q,o,
3 GtylCommunit ��/�/ ,p tate � /I Subdivision/Plat Name
Al
4 Assessor Parcel Lot Block
17`C(( — ! 0
—1 * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.It Zone Project No
R 5 ,4-45 5"
6 Dwell 0 No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front (L)S-1 (R)S-2 1 Rear Census Tract I Module Initial
It r c.- -
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor F rm Nam
�
j
Street Address
(1(2 _ ( jai", z � t
� Arq
oq�
city % oe
q,(1,_, 0(,. 4,karz.,.... ( --0 ) q2c ' 76
Contact Person
License No. Phone If dif erent than above
( )
8 Owner/Agent(if different than 01 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace XI Other
El Fire ❑ Demo ❑ Add/Alter Move tr—C
14 Describe Work d
.5---/-e-d i/
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
Lender Street Address
Zip City State Phone
( 1
Contact Person Phone if different than above
( )
Additional I/( d /ormation < gl�
( ,e 3 5��'
/ f77 ryi.6 - 54-0o