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1985, 03-04 Permit App: 00004431 Residence ' (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) 4 J Project# illt 73/ Owner's LASTFIRST MI mai?'/ &//i///1j . Project Address(Street Name&Number) 74 E r l c�-e� it— vc_ Q � Ci � �`r'�,�( ��� • State Subdivision/Plat Name Parcel No. /v [BIeckLotRat# Zone Act.M Zone r. I Census Tract Dwelling# � No.of Buildings� Lot Size(Sq.Ft./Acre) Depth��2. �^ Frontage� Front'Setback Left Right Rear V ApplicantA dress c"nt cud�ert /70�f We,1.\e-s oA `f� State ZIprfij l Phone ) (42.4-_4 Z 7 Business Phone ( ) Contractor Address re0 i q /I\CLCOweel State Zip Phone ( ) Contact License No.(Required) Business Phone 6)E NSeZ—,24,N 5 ( ) Architect/Engineer Address City I State I Zip Phone ( ) Contact Business Phone ( ) 1 Lender Address City State Zip Phone ( ) Describe Work , . Res. Comm. re c. Si de/Ve • �1 'cr/i r-d Additional information Square Footage /erih� Ocnfraefcr L ii"eNs e, 07o F w zc = zF U, z / V7 - uIS w m I- 410 : 6 . i. 0 z . a w 40 I yj V 1. !:.; o = � 4Ie-- ?.�7 i I �I �' � rid..../....0 L Building Technician ,C 'rte" 1 Grou Type ,,Li .......... 6 u • DEPARTMENTAL REVIEW Approved CoHold ApprrovalEnvironmental Health Application# 5— Of3 fifzidej W.1101 College /� [�21 �(Y', "05 Room 200 '� ,Planning/Zoning � 3111'- N.721 Jefferson 5P-63 2.64 __CI cJ it14„,1151. Engineers 9 i / , \14 0 N.811 Jefferson 1 ����•�- 1 Utilities &/p 3j7 astarAltr / 7j 1=1 N.811 Jefferson Plan Review/Fire Prevention I�,k ❑ 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 jr7144, ,,,0/ if--271-- -tk • ‘ P // _......- •_;...,,,,,..f.Wrs+,.F�A+�aik .` hn++�.C••' :1•,,,,;:,:`,....-,...F.'2'4:;.,: e. 3 . qtr-''•i - - '-� � r f r z_©/s ._'fids ,r( fes-Q' W.-14(i 1- ' volvf - - • 7-ii. 1/ - _ .,,,-,T . _ ,_ _. _ _ :- L \ ," IC' 1: _ n • L i� • .�# — t �u�w7s4 11I\ - I i �.: 1 ckl'?:\ ' I . �' yam. 4,-,-.I.',.744+'Lim az-�yy,- •x, t. • _.)-� •j - i �i. _"_' .:... • :. .._ • ZOO rt N • p •N _, 2 I (2. XO�' I_ y I )� I . I; , .may +�sxr. 7.-',.... -,:...57-',A-..; S:: AfC.t:` *r.+.....�.r ..' -.. :'-'...-''.".7."''' '... _ ;cam • - ..- • x r,41 'i;. iA 'ii is tir • , . II. .S-X•'' I_ I �, p \ a- g'd , N tiouse ` . t -7- L y ir :` �--�-T `� --_q't'r. T ° :., I qv '. \\%. I * I 1 _ ! \\VI% . \\f t Y:e 1t f 1 r, Eksencr4r f 3. • ' I \ I 13,6_71, - �_ ...:.-, _.... ♦ _._nm::ii6: rs.x.. .-:. _) .{i_ w. i...:tis::? t., r t.,i..-�..�.:f .....s_..a+FRi-,+::�..`�nwa,:::.. r 1