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1986, 10-15 Permit App: 00013914 Duplex(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) VI IP'wIv F1flCFAV FAfIL rlJfl vCrfn 1 IVICIN 1 FAL VJC I Project Number Owner's Name LAST FIRST MI LIMA. FL CSO, Project Address (Street Name & Number) Zip $. g2/ q- c8 C'A2u"A) S r Q7..7 /‘, Applicant Wo Z. ri Az Co. Address S- 7/7 P/,t/eS City Dki Ne State W A - Zip 9a o& Phone (.Sy) 9,2 3' -a s'9ov Business Phone ( ) 601mg—__. Contractor/Agent G'Y1r02_/ Address City State Zip Phone ( ) Contact V i ,v e .e ;pia License Number (Required) IO oh. F1... C, -X /401.m Business Phone ( 09) 9d8 d , -9. z Architect/Engineer Address City State Zip Phone ,,/ Contact's ���� —/"� Business Phone ( ) Lender / F/ T ,F9-n!C .4/,R -R yes /))" ' Address City State Zip Phone Werk .,rc} mF 4 PI Rea. - Comm. ivision/Plat Name/Short Plat Number 1-0(4w eR S Q/1711o4J Assessor Paroel Number 023s5/3Jig07.233-1,/ — .3.3©8 Lot ,s 7)4 8 Block / Plat Number Pertinent FHe Numbers + Zone 't -Q' Comp. Plan Census Tract Number of Dwelling Unita Number of Buildings Lot Size (Sq. Ft. /Acre) /1/ X 7©i Depth Imo.{ I I 4 Frontage q Front Setbac Left Setback( Right Setback©1 Rear Setback R/W Width Additional Information s r.\©SO1 _.o3 NOQ+ - 1 BUILDING INFORMATION Square Footage ' mF, Ili 3P = god °-� � Ea - I05" m foo . Is P (4-= 32cN Sc _ (01'- 01' -59(r 59 (r. C. , Number of Bedrooms Bibi ng T niclan .� Date jov�.$c s 2384 Group Rr3 Type Yti6 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 tie and correct. Signature Date /0/4/A Approved Cprov. Approval Hold / Environmental Health Application # t� -/6- (Scat r,ri V/ (r/�Jj„ W. 1101 College Room 200 ,,,ore....44..e. ypo-7,04;2/Lad,/4-4, Planning/Zoning N. 721 Jefferson i Engineers / / / [a �k %�/ N. 811 Jeffers n d1 -1 -Law_ � / -0 / _i 0'2-.10 P/4/6 A. 4 Utilities N. 811 Jefferson l 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 tie and correct. Signature Date /0/4/A PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 7,0 f f i(11) lid' -S o� 46 I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR AGENT DATE APPLICATION Project # Owner's Name Last First MI Project Address (Street Name & Number) City State Subdivision/Plat Name Assessors Parcel # Lot Block Plat # Applicant Address City I State Zip Phone Business Phone Contractor Address City I State Zip Phone Contact License # Business Phone Describe Work Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): Urinal(s): WtrCloset(s): Lav(s): Shower(s): Tub(s): Bidet(s): Other: Type; Waste/Grease Interceptor(s): Sewer Y N Septic/Health No.: Electric Water Heater(s): Drains -Roof: REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N Lawn Sprinkler System(s), including backflow device on any one meter: Vacuum breakers or backflow devices in excess of line 16: 1-5: (Or) 5+: 7,0 f f i(11) lid' -S o� 46 I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR AGENT DATE APPLICATION MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR APPLICATION DATE Project # Owner's Name Last First MI Project Address (Street Name & Number) City State Subdivision/ Plat Name Assessors Parcel # Lot Block Plat # Applicant Address City State Zip Phone Business Phone Contractor Address City State Zip Phone Contact License # Business Phone Describe Work Fans Evaporative Cooler Hoods Electric Furnace/Ductsl Miscellaneous Dryer Range Gas Log Gas Water Htr. Solid Fuel /Wood Stove Air Handling Units 0-10,000 CFM 10,000 + CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15.3OHP 30-50HP 50+HP Gas Piping 1-5 Outlets 6 + Outlets Gas Fired Heating System 1-100,000BTU 10,,,:00+BTU I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR APPLICATION DATE o ,c3A5/c /44/5 Do P1. c 7< Nib 7E 9•8 •• 32- o a `/,16, r) E. rL. 0 clr,, LG Pi. v n13E V.C. r .2Z5 Asral o -3034-50-- PPE-0�IDS. lis. 041,4 3�� f.� • `�` -1 / '-k 0'. Z€7 St' 8LK. / , TOwNEe5 AOD g. Bair Ci )/rI i. � r.r Ni of" 7, /3tj. / Te aNE,¢s //Da. 8�{o CALLln� ST. La? 2m e /,A.T.4.2.,I