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1985, 12-11 Permit App: 00009098 Residence • E s (THIS IS NOT A 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) SHADED AREAS ARE FOR DEPARTMENTAL USE r fl ;K I Owner'sN L T FIRST MI �mCtza((,,/JJ� ,� Uma s- --TA)s Project Address(Street Name&Nifnber) Zip /997SS � F / / Applicant . Address ,4 ,'V,gL,/,z Sr.4 4/176s �.�� S, /a Fie Yr - ' ?a3 City State Zip Phone �Po���vt� WA 9i�o� (6-41) a3s- 4 o z Business Phone ( ) Contractor/Agent Address � '1e /1. Ph P'A S, /0 F���i4 - Suir�v�G3 City State Zig Phone S Po K�+•v t." Lv� 95. 0 4 ( ) 7., aB4s Address 14/ite l4 Contact ddressContact License Number(Required) Business # Phone hone Phone )Architect/Engineer A 1.4°C)6.- Zip (�'4-i / AC State Business Phone )(City Address Phone )(Zip rok o-Lender • t�P t State comm.i r# i,i 8 , ,# ,, :City o- +t4 X ; k am ',.''4S.';',-:, :-.''''aM' : --,:**-- -., ':',',7v 1, t s : faro a -" 'AM x .. x ak? s� �* %� ,� ` vk tcF at A ,,0'!''''.': '.•''T x x � A ymsw $$9ro : A 1ug,".� k�i4.1.7 _ : :.�a� > vs` n 4cA �A '77 l''' 44:t .::,:34-r.:,:::'4:417.0: 4-47-41,111Z Srg a 7t ¢rrie d° s , „' " ,# q_ w" Cr %re ::x ^ tr t: ` i#a q:ttt ' ttvxt se_ txt° & x v A ,9 a /I � : m e : bfia a43SW.i4 . "til.4 Pe, ge a � p ai ,aY ` th r fl g ix x µ �1 p Mr 1� ro� 4 "r t r rxtP'iP:. ,r ?p1 ilt.41,44tAArgettiOMEY.f1:;.1..:it Sii 2:422ileg2;','Z'-'4:2k13',ANIWI 'rt''''''''''2':::::::::'''''''''.,1.:::''2':22''''''''' ':''''''':''1.'.2:?'''''''Il.: il .„d a 8ed Po i .. o ata -g x �7. :-roe de ,-s ,W -TwdJt aa ! -w* ,aa rw'ol” f-« e t 4 �' * ' , x � # . ,2� 7 il � tit, , a �, § ` gy . ; a3r# " p ; t " r s �' t.., t ` a s ' = z' t e " �` � aaz �� ,a„' ,. . : y DEPARTMENTAL REVIEW Approved Cprov Hold / ��� Approval Environmental Health Application# eerl g r.:41,Z ❑ W.1101 College —/, '""FS - Room 200 Planning/Zoning ❑ N.721 Jefferson 1 I, Engineers ❑ N.811 Jefferson FNS' 730 Utilities 0 N.811 Jefferson Plan Review/Fire Prevention ❑ N.811 Jefferson Other(SEPA/Critical Material/etc.) O 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. 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