1985, 09-24 Permit App: 00007654 Siding *('"A4/1 1
(BUILDING 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 ry past) (first)rs (m) I Department U.1p r�jy
A 0 �-e_ e 5- /?6 V---*
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2 Project Address(not Mailing Address)ar Road Name ++�` Space Zip
r Iyo�. 1. — Ayt. ggorl
3 City/Community j r State Subdivision/Plat Name
4 Assessor Parcel No. Lot Block
S5 1I 7 --I o o l I59 * * * DEPARTMENT USE ONLY * * *
5 Sic Code _ Zone Act.# Zone ! Project No.
AG,
g I 1&64:7
6 Dwell k No.of Buildings Sq.Ft./Acr Depth Frontage
7 Set Back-Front 1(L)S-1 (R)S-2 tRear
Census Tract Module No. Initials
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm N m aStreet Address
in�� 6� p� ()P)// K i.--fr)ir .
fl'5/of. City ., S Phone
21 SpaIra.�e_ G(1 (soq ) 91.01/fL2. -
Zip
bYC
Cont n / )� t
License,N�o/J/� /�// /�yJ Phone if different than abovvee/,/,,// /fi
8 Owner/A ent if different than# e Business Address
9 Zip City State Phone
( I
12 Review Required Plan Check(Y/N) Other(Y/N) 1 SEPA Exempt(Y/N) Date
15 Type Work ❑ Bldg ❑ MH ❑ New 0 Replace Rf. Other rein 1
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work /
}fte_y t .51Cel 4 ) SD (-1 4- F-a_Z(a---
10 Applicant Name U Street Address
11 Zip City State Phone
( )
* Lender Street Address
Zip City State Phone
( 1
Contact Person Phone if different than above
( )
Additional Information
04,/i0C1 /0 /4 •.( 4$ gostoo
&fest./ �7 ` i g7oF0° 4 /, 50 q7_�
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