HomeMy WebLinkAbout1984, 12-06 Permit App: 00003691 ResidenceBUILDING 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 (last)�_,r •7((1firs/t) (m) Department llse Only
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/�/To%'�O/✓_- //7C//i%/%.S 1'8v. Comm
I
2 Project Address (not Mailing Ad ess) cr RoadN e Space Zip
N S S 2 S/ s: K0,4a .1.-'-• -
3 City/Community
State
PVA.
Subdivision/Plat Name
Sw,i,vS de eeS act /110/, ,4,>,/
4 Assessor Parcel No. \
��J'Inl
S-sQ !_ 3 - 0I o4 fro Nop \
1
Lot
Block
♦ • t DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act.*
Zone
% /
I'/Sq.
Project No. ,Z ��
`DepthI
6 Dwell*
No. of Buildings
Ft./Acre
9-b l
Frontage
ci
7 Set Bade-Frgnt I(L)S-1_ (
4 /Jll
(R)S-2 1 'Rear
/4
Census Tract I Module No.
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16 Architect�lFirm Name Street Address
Si v✓I OLSC d I C f / VL.y -S)'?4 ue
Zip
9920 .
G
�'04.9NP
State
kirq
Phone
(Soy) 92_Osso
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Contact Person - CI t....:
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w( oLse, /
Phone If different than above
( )
Contractor Firm Name >
/7C60Co.vsrewer7o+✓ ..
Street Address
E/86/7 /94/6-85p4 -
Zip i.` "
??Q/6,
City ' '
U,Eagmi4aPFs
State
I 1")/1-.
Phone
(509)927 -oz -72 e"
eSntact Person __mar �, /
/c�UCC_//"�/1-/!/-i5
License No. r -� (� [�
•XeEmc`7t�
Phone if different than above
I mac) 4(c- 969 2-
8 Owner/Agent (if different than el above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required •
Plan Check (Y/N)
Other (VIN)
I SEPA Exempt (Y/N)
Date
15 Type Work 'M, Bldg
0 Fire
0 MH
0 Demo
X New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work /J
S/ NG Z /Cd- licy_ /('r'S./ c .... _ . _ .. .. _ _ .. -
10 Applicant Name
aRUr� W477/s
Street Address
6780f7 siii
11 Zip
q90/ CC>
City
&4(9e,u,fc.ee S
State
w/i
Aline
159) 9'2 7-O Z72._
Lender
c .Sm,o e fl -
Street Address
/- -9/o L J,4. 6/iN6-7adij
Zip
City
S'/�D,4se.
State
Wd
Phone
1 ) 326-6 9ro
Contact Person
7k7A
Phone If different than above
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Additional Information
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ZF=SDC, fi
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at
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit Issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/ Comments•
❑ Commercial; ❑ Residential
NJ New Construction; 0 Bldg alteration/addition
0 Additional structure;
APP CATION #
—/3& o
ysolooyo
Release
Release
w/cond 1
Hold 2
1l It S
'a.
^�
z
Planning/Zoning:
N. 721 Jefferson
O Commercial; 0 Cert. of Exemption; 0 Frontage;
O Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments
Engineers: 0 Commercial; 0 Residential; U Flood Plain;
N. 811 Jefferson 0 drainage new access/approach; 0 fence;
O road improvements /y �)
Conditions/Comments' /CN�1 — fp o / - l4 .XEP- D 413
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
plan Exam
'Ire Prev.
)26
Conditions / Com men is •
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
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