Loading...
1985, 08-19 Permit App: 00006960 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) SHAUtU AHtAS AHt FUH Ut YAH I MtH 1 AL USt /,/ I Project Number t7 Vo a[ Owner's Name LAST FIRST MI //1C2LTWAJSEAJ j bek..Y Project Address (Street Name & Number) Pdare, Zip - Z906 . N.- (9n--3235 < /9y/y Applicant y et crOn A96 S rens /!19 At .. At..Iss a, City /'Po ``i State Go Zilq q yG� Phone (rO9) _ Q tri77 `1 Business Phone Conir /Agent n3 (.02. x..35143 b.L4 e Ls�ou �oc t s Add ess n / / / f N/co. S a City SPv i State /AIR, Zip 0141-06 Phone 's Ste' -..set --77 72;c1,3License _cur %d Number (Required) Si oP*>6JdP ne Business Phone ( ). Architect/Engineer Address .. City State Zip Phone " ( ) Contact - - Business Phone Lender Address City State I Zip Phone ( ) Describe WokiLi c-7)>�1i� J W -t Mrh _ € A36- a) L Res, / 1............0./.- / Comm, 4ubtlivision/Pisii Name/Short Plat utS Ming Assessor Parcel Number X 07fr42 rO % ©�- Lot i'C lock Plat Number Pertinent File Numbers Zone Aasaa Comp, Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft/Acre) Depth Frontage FrontSetback Left Setback Right Setback Rear Setback Additional Information - • 1 DEPARTMENT USE Square Footage Building Technician Date S -/G-0 Group Type 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 is true, correct, legal, and binding. Owner's Signature Date Approved • Cond. Approval Hold Environmental Health Permit Number Q,�� A/ y ^+(� /9� W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson _ Permit Number Engineers N. 811 Jefferson Utilities N.811 Jefferson -' .^ r Plan Review/.Fire Prevention N: 811 Jefferson - t - 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 T I I{! 1 1 � ! j t i 1- ' j r- 1 I T H-4 f, T r - I- -1-j , I 7 L H I 1' T -i i t ;— I--- -- I r, 1 I 4 j•+ J I rt ) I! f I -I T--- I I- T I 7I r I 1 ! i L i II , I 1 I I I± I— T 1 1 1 1 1 1I 1 ' Ci 11 I i T I -r , r%fS' _ i u l 7I I I I I ti tie .5.1/74.6•••••,I I -I 1 I ------{-, i �y t—� 1 1+ 1 1 .sem ; f'- H I ! r L -I - I I I! _f .. J- _A 1 > j- t r t ) I -I I - --i- ---- j - I ----=-- -E--- - r --'----I--' ` ^V I r. I 1- - 47 � v wP I / _ _ v I I I , ' I i r j i )- 4 --1 - �I 1 11 1 I �11 I i I i i ! I i 7 1 � i i 1- i -- I r 1 i t Y .. - I --j----, I � i I I- - I { ! 1 J 1 1 I J 1 H -I- ----I - -f - - ,-rt- 1 ( t I 1 r ---------'j--. I- 1 11- I --- +- I 1I 1 I 1- -- ---1 l i ! 7 1 1 1 1! 1! 1 1 ; i i 1 H H1--� - ---I 1 Legal Description iN-G-JtJQ,CTff /KJ Show on Site Plan: ‘ Additional Information: 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 ps r4- s . PAGE '7S, r4/ 5,00A-AJM ecu.. ray, t d.45,F�.c/6 g, ' T I I{! 1 1 � ! j t i 1- ' j r- 1 I T H-4 f, T r - I- -1-j , I 7 L H I 1' T -i i t ;— I--- -- I r, 1 I 4 j•+ J I rt ) I! f I -I T--- I I- T I 7I r I 1 ! i L i II , I 1 I I I± I— T 1 1 1 1 1 1I 1 ' Ci 11 I i T I -r , r%fS' _ i u l 7I I I I I ti tie .5.1/74.6•••••,I I -I 1 I ------{-, i �y t—� 1 1+ 1 1 .sem ; f'- H I ! r L -I - I I I! _f .. J- _A 1 > j- t r t ) I -I I - --i- ---- j - I ----=-- -E--- - r --'----I--' ` ^V I r. I 1- - 47 � v wP I / _ _ v I I I , ' I i r j i )- 4 --1 - �I 1 11 1 I �11 I i I i i ! I i 7 1 � i i 1- i -- I r 1 i t Y .. - I --j----, I � i I I- - I { ! 1 J 1 1 I J 1 H -I- ----I - -f - - ,-rt- 1 ( t I 1 r ---------'j--. I- 1 11- I --- +- I 1I 1 I 1- -- ---1 l i ! 7 1 1 1 1! 1! 1 1 ; i i 1 H H1--� - ---I 1 Legal Description iN-G-JtJQ,CTff /KJ fc.Er=T Or •Trier= , Scan, 30C FEar G F TR4cr7, E4ECre ,OP/r,o. i, AC -a- ro PG,3-r Rccu,Qoao �,tJ in4-ia01 '#D"o,= ps r4- s . PAGE '7S, r4/ 5,00A-AJM ecu.. ray, t d.45,F�.c/6 g, ' Stair 1 l ' .2° Date: Revisions: Attachments: T I I{! 1 1 � ! j t i 1- ' j r- 1 I T H-4 f, T r - I- -1-j , I 7 L H I 1' T -i i t ;— I--- -- I r, 1 I 4 j•+ J I rt ) I! f I -I T--- I I- T I 7I r I 1 ! i L i II , I 1 I I I± I— T 1 1 1 1 1 1I 1 ' Ci 11 I i T I -r , r%fS' _ i u l 7I I I I I ti tie .5.1/74.6•••••,I I -I 1 I ------{-, i �y t—� 1 1+ 1 1 .sem ; f'- H I ! r L -I - I I I! _f .. J- _A 1 > j- t r t ) I -I I - --i- ---- j - I ----=-- -E--- - r --'----I--' ` ^V I r. I 1- - 47 � v wP I / _ _ v I I I , ' I i r j i )- 4 --1 - �I 1 11 1 I �11 I i I i i ! I i 7 1 � i i 1- i -- I r 1 i t Y .. - I --j----, I � i I I- - I { ! 1 J 1 1 I J 1 H -I- ----I - -f - - ,-rt- 1 ( t I 1 r ---------'j--. I- 1 11- I --- +- I 1I 1 I 1- -- ---1 l i ! 7 1 1 1 1! 1! 1 1 ; i i 1 H H1--� - ---I 1