1985, 09-10 Permit App: 00007382 Swimming Pool•
--- (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)
SMAUtU AHtAb Alit YU11 UtVAM I MCN I AL Ubt
I Project Number --78e
Owner's Name LAST FIRST MI
WA -Ise. bAtP S
Project Address (Street Name & Number) Zip
E , i 'LVL Ro®n& Akita 992A6,
Applicant
^/ _- ` (\'�� p� (� (�
1 31\ !J W L NNS2-►J
Address /�/ r f//� r� /�,�/�
1 ( / NO. ! [ %%LS 2J j
Cit �h�
\J Vl
State LOP,
E ^ Zip ^e
Y SCJ�
Phone
( )
Business Phone
Tell 992—S5-7 9
Contractor/Agent
u.TO i1n
00L
S
Add
ess
/ 1l 9 4,19, i°Azs 4a.
City cPQ t� l ,v �r
Stale iN A - r
Zip�f��
Phone ( )
t
£
1t1 SW --S EA.)
License Number (Required)
P
0 �6 f .aP
Business Phone
IJ J. f tg—CZ7Y
Architect/Engineer
Address
City
State
Zip
Phone
I )
Contact
Business Phone
Lender
Address
City
State
I Zip
Phone
( 1
Describe WorI3Ne�! fax 3`Y
'Res.
Comm.
Sub 4l talon/PctJJame/Short Plat Number.
,9b % Od
{ ^meq �/.��('�7� /�/
l0 lJ&Z93� i t g , (2 uys
Assessor Parcel Number
,3
'efI> —3V-04
Lot
.Block /
Plat Number
Pertinent File Numbers
ZoneEr
Comp. Plan
Census Tract
Numberof Dwelling Unns
Number of Buildings
Lot Size (Sq. Ft./Acre)
12106
Depth
Frontage
Front Setback
Left Setback
RIgt1 Setback
Rear Setback
Additional.. Information
I DEPARTMENT USE
Square Footage
Building Technics n
Date
Group
Type
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Permit Number
4
Approve
Jh'f n
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N.811 Jefferson
Permit Number
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
•`J
ti
Show on Site Plan:
Additional Information:
��
^`F
•
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells■■
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
II
I
�
f•%_f•%_}—r
�1,
V/ •
1-R
£
c__
—
---�
..
<-
ygL—*
Legal Description
L
—
■ Q�
B■N■
)� -->
Part(
L/•
�tr
f
■
I
4
H
,�
t
II
'
I,
1
1 I
-
---
I,_,
1
1
•
y
NEW
Flap. IN
Pahst. I
N
IA
/
Scale: — S
If
Date: 9/q/ie
Revisions: Attachments: