HomeMy WebLinkAbout1986, 08-05 Permit App: 00012492 Residence(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project
Owner's Name LAST FIRST MI
__,....Set........ Gef- dA.) 4 .
Project Address (Street Name & Number) I SC/ g 1S V w
r(eT (6 6 ic ', (-ice,-/ Zip
Applicant
SG
e t t
Address
),,2-2 P, t e.4:0.
City
�.�-4-64-i'
State
t. -J cJ.
Zip
9q�i�
Phone
(.Aa'7) sc66—&(7/
Business Phone
( ) S
Contractor/Agent
Address
City
State
Zip
Phone
( 1
Contact
License Number (Required)
e .S.0L6A
C .''Z
Business Phone .•
( )
Architect/Engineer. ..t
ll
y/Q O I ] V
/ V
Address
City
State
Zip
Phone
( 1
Conte*
Business Phone
( 1
Lender
Address
City
State
Zip
Phone
( 1
Describe Work
(I�
Res.
Comm.
Subdivision/Plat Name/short Plat Number
-c--P. -11-1112-- e ,ce... >coD
Assessor Parcel Number
7(i',6 7 i — d '(1
Lot
li.)
Filnck
/
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth•Fronts
e
I. t Setback
.:
Lett Setback
Right Setback
Rear Setback .. ..
R/W Width
Mona! Information
BUILDING INFORMATION
Square Footage
(cfc=ciF
yi.
:
^•E
Number of Bedrooms
ding Te t nlcisn ; Da
Group
Type
0
0
0
DEPARTMENTAL REVIEW
•
I certify that I have examined this application and state that the Information contained in it and submitted
by me or my a to compile said appl Ion is true and correct.
Signature Date 7-30
Approved
Cond.
Approval
Hold
Environmental Health Application #
4,b T�s%/1
41./
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
E. 811 eff 44a q/7
N. 811 Jefferson ��!!
----�,�,
/
i/
I
Utilities
N.811 Jefferson
'
Plan Review/Fire Prevention^1
N. 811 Jefferson - � V1u ••••••••.,7
I' 1 ' K L
Other (SEPA/Critical Meterlel/ete.)
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 a to compile said appl Ion is true and correct.
Signature Date 7-30
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject 0
Owner's Name Last First MI
Project Address (Street Name & Number)
S , /SD V 3J,-iF.-a -/°
City I
COte-�^)�
State �/
LI PC Gtr
Subdivision/Plat me
� lebeiC
Assessors Parcel It
Lot _
10
Block
3
Plat/
Applicant S�'�6
Address
City
I State
Zlp
Phone
Business Phone
Contractor
Wet c„ir esu 6•4.)1
Address
City State ZIP
Phone
Contact
Licenses
Business Phone
Describe Work /a r `, K ru ra E`�
�/�
Bar Sink(s):
Drinking Fountaln(s):
Floor Oraln(s):
Washing Machine(s): I
Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray(s):
Sew Eject(s):
Urinal (s):
Wtr Closetis): '7
!�
Lay(s): L
Shower(a): 1
Tub(s): I
Bidet(s):
Other: Type;
Waste/Grease Interceptor(s):
Sewer V N Septic/ Health No.:
Electric Water Heater(s):
1
Drains-Root:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: V 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+ :
mix V =3C.
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
APPLICATION
OWNER OR DATE
Project 41
Owner's Name Last First MI
Project Address (Street Nameme�& Number �7
9, ,Jt Pi YO /T —4-(j./J
City/�l
^70`G
State w�r�
Subdivision/ Plat Name � ?�
,�-79
locckk �/
Assessors Parcel 6
Lot
/0
3
Plat 44
Applicant
Address
City
State
Zip
Phone
Business Phone
ContractoA-1--PA)
rjj � G - , //� /_ ,, /�
A -1--P A) so.e!- / `)tVAe-L
Address
City
State
Zip
Phone
Contact
License 6
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Flange
Gas Log
Gas Water Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over1750M
Compressor
0-3HP
3-15HP
15-3011P
30-50HP
50+HP
Gas Piping
1-5 Outlets
t
6+ Outlets
Gas Fired Heating System
1-100,000BTU
,
10,..,;00+ BTU
IPA. -00
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
APPLICATION
OWNER OR DATE
V- • .
'HAYSTAcK'ROcK
ourC ROP' NU
Icm AAL PRECAST'
SEPrzc TANK w/
5co GAL FUMP
CHAMBER
= LIMITS OF PRESSURE MOUND
_.EEWAGE-'ABSORPTION4 FIELD)
'r SEE MoUNP 4 PIPING DETAILS
•
• -, -7
1
SITE ELAN
ONSITE SE\uA6E SYSTEM
LL -
Show on ite Plan: Additional Information:
Lot Dim
Existing w turesT—\:
Propose rovements
Structur etacks
Easeme
Septic Sy- (s)
Water Li
Sewer Lin
'Fences,
Driveway
Right of Width(s)
Names ot
Fronting eet
Flanking eet
Landscaping
Drainage Plan
Hydrants
, Topography
Lighting
Simians
Shorelines
• Highwater Mark
•
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Scale:
Date:
Revisions:
Attachments:
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