1985, 09-06 Permit App: 00007282 Siding 70
UILDING 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 DepartmenyUse Only
6/{ [l(0'1 if_h, l �' 1,h(A r� r RBS. Comm
2 Project Address(n Mailing Mailing Address)or R d Name Space Zip
/1 • /. 70-3 (? - �I9'ao.'d
3 City/Community t e Subdivision/Plat Name
.` 1 1,4/1 O, 6014-- i `7 S `� l 'D�6,C4 Assess() Parcel No. Lot Block
-2-5 --q 51 ) ,t , * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. 2-A-2,
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front (L)S-1 (R)S-2 1Rear
Census Tract Module No. Initials
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
/. Contractor Firm Name StreetAddress
'' e,l/� n/eV1.424*a.t (ZO-e_Z-7: 'State Phone3/6 4 r /f'�12
Zip lqg 1. , 9
4 Gtr (5-a9 ) gay- yby ,
Orrt Person License No. Phone If different than above
/4v-irAt__//.� _ /1/1/1. 64-41A 31/6M ( ) ✓�6-
8 Owner/Agent(i different than#1 abov/ Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(Y/N) I SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace yr Other
0 Fire ❑ Demo ❑ Add/Alter ❑ Move rPpal/7---
14 Describe Work,9,_ J VVV / f �-
_JO
10 Applicant Name Street Address
11 Zip City State Phone
( )
* ` ,t
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
L/O/.0-(Z_Zi1 q/y, , Oo
PiAZI471;11- Fie : (�I 03 i_ /, 50 6.2. .50