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1986, 05-20 Permit App: 00011516 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) SHADED AREAS ARE FOR nFPAnTnt1FNTA1 I ICFi.r_►_. Project Number Owner's Name LAST FIRST MI /tJ C Project Address (Street Nam & um r) -- Zip Applicant Address City Stat Zip ,,l - U Phone Business Phone Contractor/ Agent -j { Address City State Zip Phone ( ) Contact License Number (Required) Business Phone Architect/ Engineer Address City State Zip Phone Contact nosiness Phone l v Lender -- - - Address tatty State Zip Phone { ) Describe Work �lf Res. comm. Subdivision/Plat Name/Short Plat Number — Assessor Parcel Numbor Lot Block,t Plat Number Pertinent File Numbers Zon Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./ Acre) Depth Front e t �� Front Setback Left Setback c Right Setback 1 Rear Setback R/WWidth 70 t Additional Information Square Footage ff0 y 0 ILL Z_ a z 0 J_ M Number of Bedrooms Building Technician Date i. Group Type t.� -517 5 a T n DEPARTMENTAL REVIEW 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 Approved Cond_ Approval Hold Environmental Health Application M W. 1101 College Room 200 -7006 -� Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson Plan Review/ Fire Prevention N. 811 Jefferson 2 t r7 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 IJ �, �{�'rF �• #' a Pi # '�: f !'�,( 1 r.', � Ihi Z i �i y L. ��5�' 1 i`' �..r:.:1.1� r �. .f 1! i:'i ! � ;,'�, Fn �'� a�f (�����tr�t r �r����i� '��t�xil�l� �i�hi.:'. p`c�i ;()!'�i�;� t. II •1��. I ;a: i 1t '.1' 1.,Tt1f,St �C., . �. k', ,si r 4a •i ttAi �i � :- 1• i�l�,+� / , � j��r � � r+lA�,i f !r ', ` f` .G�i. ' 1.7a •, ,.`,. I , s</%t , �-l� ' 'P/ . v..bgi�"1 A tSit � f 'i, '. 1i .I, ..! '.� A !'.b e• I (a , , r,., jy, �`!.� i ,v f r/ '`f'r'y I „� r � t a, /J.r�+ •Fj/ f �y ,t d.�! I F- f ir,�t f a �'f''ia}� •� ' � 1 s; � n 1 p' : { d dOA f---------• D¢AI N F 1 Gl_b- d :_LO- O • j-�-- �4 .ice 4At.. SEPT%L T&►"V- ' 3o¢- `0 ` G�• „ - "t W -r LI,JE \ (0 _._... d' 1 /e _.. _...... _ 4 _ ..•.. •_ _ .. _ .. _... _ _ ff . _ ... _ .. ._..... . i � 1y.l:n, :. y.17: trti •r p;•+,� attiYft: +�,•.� .:..... A ..t.., , %t••I, ..� r.:.. ..r-.Ivv. 't.. r:y.., n t v ,.... j .. • __ � —._. '. rt///1. �.lL tOOIRTY L1a.lt � T• r: tlr4,xa. ' t t�l +1 f: f •.r i i �q y '' �fplPd .ii�Ptlp(ifnrr upyili$fA'r1lPl;it!