1985, 07-02 Permit App: 00006200 Swimming PoolBUILDING 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)
ti
*
*
1 Owner's Name (last) (first) (m) Department U Only
/ / . __ !�1�/ Fps. ' Comm
2 Project Address not Mailing Address) . Road Name Space Zip
;1d,�.� 92-e&
/ /2/ >
3 Ci y/ .mmunityt
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ate , . /�
�� et
Subdivision /Plat Name /
/11/44/ 55 i O n/ It i /IS / S % A 0p To
4 • • -,..r Parcel No.
O t 6-z1j7' — ogo z
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone A
' Project No. / L� :
6 Dwell #
/
No. of Buildings
/
Sq. Ft. /Acre
Depth
110'65
Frontage
eV
7 Set Back -Front
I (L)S -1
(R)S -2
!Rear
Census Tract
1 Module No.
Initials 6`,4-ea
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City j
State
Phone
( )
Contact Person
License No.
Phone if different than above
( )
8 Owner /Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (Y /N)
Other (Y /N)
SEPA Exempt (Y /N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
❑ Add /Alter
❑ Replace
❑ Move
Other
14 Describe Work
fMMrnIG Poo L G)
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Conditions /Comments•
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATION # 405 '/! L�
❑ Residential
❑ Bldg alteration /addition
Release
Release
w /cond 1
Hold 2
a�
r
Planning /Zoning: ❑ Commercial;
N. 721 Jefferson ❑ Setbacks;
Conditions / Comments
❑ Cert. of Exemption;
❑ lot w /d; ❑ lot size;
❑ Frontage;
❑ use /zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Engineers: ❑ Commercial; ❑ Residential;
N. 811 Jefferson ❑ drainage ❑ new access /approach;
❑ road improvements
Conditions /Comments•
❑ Flood Plain;
❑ fence;
Utilities:
N. 811 Jefferson
Conditions / Comments
Other:
Plan Exam
Fire Prev.
Conditions /Comments•
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
1
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