1987, 01-27 Permit App: 87000205 Residence(THIS IS NOTA PERMIT) 561
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)
SHADED AREAS ARE FOR D
Project Number 66
'�S iJ
Owner's Name LAST FIRST MI
CRo, if. Or _ ', SPS //�.--L,
Project Address (Street Na e & Number) Zip
L _ / s' J' -=- 3 <"' /v (-c_ s 1, 4,
Applicant
Address
x 3-71-7
City
State
Zip
qq213
Phone
( ) 9 z -2 —2 -
Business Phone
Contractor /Agent
Address
City
State
Zip
Phone
( )
Contact
Lic a Number (Required)
a5t -t-21ehU L
Business Phone one
( )
Architect/Engineer CFP5/67
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
( 1
Lender
Address
City State
Zip
Phone
be Work ,
Res.
Comm.
bdIvjsionIP1at NamelShort Plat Number,
G.parcel Number
Lot
1,
Block
Plat Number
,4` se
PertinentFtieNumbers .
Zone ay {
Comp. Plan
Census Tract
*umber of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth ,
Frontage
tt_
Left Setback
t F
Right Setback ,
Rear Setback
NM,/ Width
jtionai tnfcrcmatjon }
"BUILDING INFORMATION I
Square Footage
1 I-7 2- t.,tj''
f br'r
,r.
Number of Bedrooms
Bullding Technician
Date
Group
Type
DEPARTMENTAL REVIEW
certify that 1 have examined this = • , li . errand state that the information contained in it and submitted
is true and correct.
by me or my agertt'to compile s
Signatur
Approved
Appro al
Hold
�y `
Environmental Health Application # 'efe)
?
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson 97 if9VA O / 7
/ 7/47
a
Utilities
N. 811 Jefferson
I
/2R'
Pian Review/Fire Prevention
N. 811 Jefferson
)P't/4
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
certify that 1 have examined this = • , li . errand state that the information contained in it and submitted
is true and correct.
by me or my agertt'to compile s
Signatur
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 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
/1\A/AICD f'1l1
APPLICATION
1-1 ATC
Project #
Owner's Name Last First MI
Lied 7 9' i-004' ,7,r'(S c--- / 4r c_
Project Address (Street Name & Number)
City
AL
State �
t(9-7 '
Subdivision/ Plat Name
S •-•19---1/ 1' ex-
!�/f} S 7
Assessors Parcel #
Lot /
Block
Plat #
Applicant
5--.-1/4.--
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/
Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water
Htr. is .60
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
15-30H P
30-50H P
50 + H P
Gas Piping
1-5 Outlets
/ l
+ Outlets
Gas Fired Heating System
1-100,000BTU
1'
10� ,�00+BTU
1 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
/1\A/AICD f'1l1
APPLICATION
1-1 ATC
101.0
PLUMBING PERMIT' APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Project 0
Marne Owner's Nae LWFirst MI
I
C._7 c-' 4 /.�5? �( tip'-'S� ! �(/c
Project Address (Str t Name & Number),
City
State
Subdivision/ Plat Name
Assessors Parcel 0
Lot
Block
Plat 0
Applicant
Address
City
I State
Zip
Phone
Business Phone
Contractor
) 1 -,------
Address
City
I State
Zip
Phone
Contact
License 0
Business Phone
Describe Work
Bar SInk(s):
Drinking Fountain (s):
6--
Floor Drain (s):
Washing Machine(s):%
DehWshr(s): 1
GarbDlsp(s):
Kit Sink(s):
Lndry Tray (8):
Sew Eject (a): <
Urinal(s):
Wtr Closet(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:
(005 + :
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 n(ot 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
APPLICATION
OWNER OR AGENT DATE
36
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