1987, 01-07 Permit App: 87000018 Repair Fire Damage I
(THIS IS NOTA PERMIT) 118• ...----)° ,
ii1-�°41 BUILDING PERMIT APPLICATION WORKSHEET
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ii � PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND •
COMPLETE !N INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE 1 � j
Project Number
Owner's Name LAST FIRST MI
U4 VI&.-T . L , ''l kl j=— c i/A
Project Address(Street Name&Number) zip
/ 7 I — cl 5 1 8--P0%,4 iv 6142 , 9 .--7,56
Applicant Address
City State Zip Phone
( )
Business Phone
( )
Contractor/Agent Address
i LC- H c C 1-f- '1_ 1-7,9-4. '66' 90 S',-/g7- 36
City State Zip I Phone
s � je> /V - 9 7 _ ( S ) .32-;— L 4/4.73—
Contact License Number(Requiatt.. Business Phone _
i(i C G ff'3 �`'6 L 1-1- ( ) . A�(t
Architect/Engineer 30/87 Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip ip Phone
( )
Describe WorkRes. / Comm.
:'4 ,F"i r E OAuAaE -ro ( ARAL ,
.., IShort Plat Number
T," es 'CST J / ce'ws 157
Assessor Parcel Number Lot Block Plat Number
335113 - /104 (47 2
Pertinent File Numbers Zone Comp.Plan Census Tract
.F17
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
l 831 ®
OFront Setback Left Setback Right Setback Rear Setback R/W Width
it,
Additional Information 4 Square Footage
41)
/D�UUD VAGtj 4T1O J
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0
P
2
cr
0
u.
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5
m Number of Bedrooms
Building Technician Date Group Type •
q4 ) I—(o—87 l•-l- 1
•
DEPARTMENTAL REVIEW
Approved Cond. Hold
Approval
Environmental Health Application N
❑ W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ 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 to compile said application is true and correct.
Signature Date