1986, 06-06 Permit App: 000111423 Garage \...��0 BUILDING PERMIT APPLICATION WORKSHEET �� 5-4?)
e. ` 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) (m) l Departmen ly
l Ra el ` Fes. Comm
2 Project Address(not Mailing Address)cr Road Name Space Zip
_ F s i '30o 5 io ( 2/,
3 City/Community State Subyii+(ision/Plat Name
C ) Qrirn/ I -- PD
4 Assessor Parcel No. Lot Block * * * DEPARTMENT USE ONLY * *2-1151/2-— /551/ /6 !o
5 Sic Code Zone Act.# Zone Project No.
2-Z
6 Dwell# No.of Buildings Sq.Ft./Acre I Depth Frontage
i 2 i 36 Ps
7 Set Back-Front (L)S-1 (R)S-2 `Rear Census Tract I Module No. Initials
\- yo I 6 4 50 _1gt
16 Architect Firm Name Street Address
Zip City State Phone
( ) 92y- ylir
Contact Person Phone If different than abo4e
( )
Contractor Firm Name Street Address
Zip City I State Phone
( 1
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) SEPA Exempt(Y/N) Date
15 Type Work f'T.' Bldg ❑ MH New El Replace ❑ Other
❑ Fire ❑ Demo El Add/Alter ❑ Move
14 Describe Work
CAA@E AnAct UE(D 17_,EE&-LC toA V (((4-/7z)
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 Information 1 ,i
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