1985, 08-26 Permit App: 00007108 PoolBUILDING 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 (Int) (first) (m)
AA
pgpgnmantt Only
y
-/-(an ` SOB S
✓
Rs. Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
1zoz &• (Carat I's le- %9Z067
3 City/Community
SAD M A#st
State
wei
Subdivision/Plat Name
O%ER i i . / ST -.
4 .assess& Parcel No.
Lot
Block
+ + + DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. 0
Zone��
Project No.
7ioo
6 Dwell 0
No. of Buildings
Sq. Ft./Acre
138ce
Depth
230
Frontage
—n
7 Set Back -Front
(L S-1
(R)S-2
Rear
Census Tract
Module No.
Initials y�
i3f te)
' 16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
Contractor Firm Name
Pool aiore.LQ htC..
Street Address
E. (S&t'4- Spit c.
Zip
9.2.1L
Clty
-;112oIca^.e
State
(,iia
Phone
1 5o7) 9zs-c,rgS
Contact Person I
'C..- f �tiderzso v
License No.
Po - oma -� s —Zvt�P
Phone if different than above
( )
8 Owner/Agent (if different than 01 above)
(
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Pla Check (V/N)
Other (V/N)
I SEPA Exempt (VIN)
Date
15 Type Work ❑ Bldg
0 Fire
0 MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
EVOther
14 Describe Work
Ste IKH/No- Pmt_
10 Applicant Name
Street Address
11 Zip _
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
Additional Information
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; 0 Residential
❑ New Construction; ❑ BIdg alteration/addition
❑ Additional structure;
APPLICATION # OgP§
Release
Release
w/cond 1
Hold 2
i i
e
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone-
El CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments.
Engineers:
N.811 Jefferson
❑ Commercial; 0 Residential; 0 Flood Plain;
❑ drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments.
Utilities:
N. 811 Jefferson
Conditions/Comments.
Other:
Plan Exam
,.. Fire Prev.
- Conditions/Comments:
Project Representative Telephone
Agencies Performing Special Inspection:
1
3
1 Indicate above or attach conditions relative to final as built approval
- 2 indicate above or attach reasons for hold
-7 /
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_a
63
ode / -1eyett
E 77-07. Ce+ r,s le,