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1985, 08-08 Permit App: 00006761 Addition } • (THIS IS NOTA PERMIT) e 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 DEPARTMENTAL the DepartmentUSE of Building and Safety) SHADED AREAS FOR I Project Number 6,1 /_ 11 Owner's Name LAST FI T MI Project Address(Street NamNumber) Zip / omal5 oz_� �" 1 12' Applicant Address City State Zip Phone Business Phone ( ) Contractor/Agent Address City State Zip Phone ( ) Contact License Number(Required) Business Phone ( ) Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address PhoneI Zip ( ) ,,,,,,,,,...,.%,maState : yt . a �, ` 4 iA 4$:: % $ City '' F, 8 t 3°" A% gyIm''pffi ' :x: s , .. L. d 4 $p am ::M'� ` "itilw .p7:.: :� tL" ¢'''''13'4-°:'/'*''''.. .'''''''▪ ''''' ��� '7''. K"'P F ,� s , . mm 8ao .a „_721."'''''''''': :::: .m .7• �:" 4 � i tf ',a �d. .M'..s 5 � p a, aN11 F ' : r- a x m � agye'm r , FF : � �� * , 4M . fi - �g'zmi; tl5�- T "�A4.2$ :644FLtl:t FnY, F qF :;;:7;;': fi :'.:i . a �! .ma,N g r? .Fia ,: tF ' F a! , : , :��ar FFr, � sQiP .' as:� a5�a Fgym.. r ..FF , ,,: • e• 4 igi:-,, 6 , S4: 4::1 � �,F ;�i0m" t�F$ dsr :a � , : aj � Ft � F � fo'af �a� s x„p t -Wr a ; a s1:; : ak . � z : " aa: � � 4 # : ift p:4g. ,� $ mf: ri .t � : :: .it - m - aY a 4:' smaea ms ,i', 1. ' : m Wia ▪m,5 + °. w °.as A:i : aa ' * �s t' t am"A b a.a , .... � i- ;a� ma ";:::':',:'::::::f:-.1':::::::::/:-. _ 4 ' 'a kiryr 8t F egis;44 � : pi a M atei% ' aa ' 3 *, sa .? F , t a le ' mm* * v'1l - a s r F - �, s F :: :_ , � � �e � ��, . , ; rN . m ., mf' m4r n r .'''W ., ' _.'":-i 1: Sa ftzi, 'a .r , T • DEPARTMENTAL REVIEW Approved Cond.AHold pproval Environmental Health Permit Number .33 �, 1 W.1101 College Room 200 Planning/Zoning ❑ N.721 Jefferson — Engineers Permit Number ❑ N.811 Jefferson Utilities ❑ N.811 Jefferson Plan Review/Fire Prevention ❑ 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 is true,correct,legal,and binding. Owner's Signature _ Date . . -• =7-• -11- , , / / ----i:' -:._. 44--„--c--1 I /)/ 1 . } ! ' A ,"7L' .--' ,......-- c-----J ! .. . ,___-----,• , ,,,, (.._), , // ) i i-- -.- !, •.---" i c-) Ill -.._. . \ - • .,\I----------------. / „31\ i N., ---- --------4.- ) '4 I 4V/Ilj /-i..1.: i. - . --- /& 1 i 1 ) , -.01..4 . --1 ( f ! -/-F1------- /C - - 1 ) _ ..., ....._ 1, (----- ,-- _